(足母)甲皮瓣与第二趾胫侧皮瓣瓦合修复拇指末节套脱伤

目的 报告游离(足母)甲皮瓣与对侧第二趾胫侧皮瓣瓦合修复拇指末节皮肤套脱伤的方法和疗效.方法 对8例拇指末节皮肤套脱伤,选用游离同侧(足母)甲皮瓣,对侧第二趾胫侧皮瓣瓦合修复.对(足母)甲皮瓣供区的处理,2例采用同侧第二趾侧方皮瓣覆盖,第二趾供区全厚皮片植皮,6例采用全厚皮片植皮.对侧第二趾供区均采用全厚皮片植皮.结果 术后8例移植瓦合皮瓣全部存活,伤口均Ⅰ期愈合,足部供区植皮均顺利成活.术后随访5～18个月,平均8个月,皮瓣颜色与正常手指相同,皮瓣无明显萎缩及色素沉着,拇指外形满意,指甲生长良好,指腹感觉恢复S2～S3+,指间关节伸、屈活动良好.供区植皮无瘢痕挛缩,无破溃,足趾无垂趾畸形,足部活动无影响.结论 应用游离(足母)甲皮瓣与对侧第二趾胫侧皮瓣瓦合修复拇指末节皮肤套脱伤,不牺牲末节(足母)趾,可以获得较好的外形和功能.     

(足母)及第二趾皮瓣瓦合修复拇、手指套脱伤

目的探讨拇趾腓侧皮瓣与第二趾甲皮瓣瓦合修复拇、手指套脱伤的临床应用。方法采用多种不同手术方法修复手指套脱伤，其中采用拇甲瓣加第二趾胫侧皮瓣修复拇指套脱伤9例。采用拇趾腓侧皮瓣加第二趾甲皮瓣修复多指套脱伤15例20指。采用双侧拇腓侧皮瓣加双侧第二趾甲皮瓣带足背皮瓣加足外侧皮瓣修复示、中、环指套脱伤1例。采用双侧第二趾甲皮瓣加双拇腓侧皮瓣加双足背皮瓣和股前外侧皮瓣修复手部套脱伤1例。结果26例34指59块皮瓣，其中有1块皮瓣坏死，经重新植皮后愈合；其余58块皮瓣全部成活。术后18例23指获得随访，随访时间为6～9个月。除手指末节指间关节活动受限外，其余指间关节活动均接近正常，指甲生长尚好，外形接近正常，手指两点分辨觉为5-8mm。供区功能无影响。结论拇趾腓侧皮瓣（或拇甲瓣）与第二趾甲皮瓣（或第二趾胫侧皮瓣）瓦合修复拇手指套脱伤，术后手指功能好，外观满意，是治疗拇、手指套脱伤较好的术式。     

游离第二足趾背甲皮瓣联合(足母)趾腓侧皮瓣游离移植修复单指脱套伤

目的 探讨单指脱套伤修复的新方法.方法 2007年8月至2010年6月,应用游离第二足趾背甲皮瓣联合扩大的(足母)趾腓侧皮瓣修复单指脱套伤11例,其中示指6例,中指2例,环指3例.Ⅰ型脱套伤4例,Ⅱ型脱套伤7例.均急诊清创VSD封闭负压吸引,于伤后3～5d行手术修复.(足母)趾腓侧皮瓣内和第二足趾背甲皮瓣内的趾底神经与受区残端的指神经进行吻接.供区游离植皮.结果 11例皮瓣全部成活.术后2例第二趾背远端植皮部分坏死,后经换药愈合,1例指骨穿过存活的皮肤外露,手术截除部分外露指骨后伤口愈合.11例均获得完整随访,随访3个月～3年,皮瓣颜色正常,质地柔软,外观不臃肿、接近健侧指.11例修复脱套指原第二趾背甲皮瓣感觉恢复达S3,原(足母)趾腓侧皮瓣修复的指腹饱满,两点辨别觉为6～9mm,平均7.0 mm.手指伸屈功能按手指总主动活动度(TAM)评分法评定,优9指,良2例.结论 游离第二足趾背甲皮瓣联合扩大的(足母)趾腓侧皮瓣是修复单指脱套伤的有效方法.     

第二趾甲皮瓣修复手指中末节皮肤脱套伤

目的　探索修复手指中末节皮肤脱套伤的新术式。方法　对 10例 10指中末节皮肤脱套伤 ,选用带有少量末节趾骨的第二趾甲皮瓣进行修复。皮瓣切取长度 2 .2 cm～ 6.1cm,平均 2 .9cm。皮瓣游离平面位于趾伸屈肌腱表面。皮瓣血供重建方式为趾 -指血管吻合。结果　术后皮瓣全部成活 ,随访 5～ 10个月 ,伤指修复后外形及屈伸功能均满意。两点辨别觉为 6～ 9mm。结论　用第二趾甲皮瓣一期修复手指中末节皮肤脱套伤 ,伤指有指甲和丰满的指腹 ,可最大限度地恢复伤指的外形和功能。     

双足趾与第2趾甲皮瓣联合一期修复多手指脱套伤

[目的]探讨双足趾腓侧皮瓣与第2趾甲皮瓣瓦合修复多个手指脱套伤的临床应用.[方法]采用多种不同手术方法修复多个手指脱套伤,双足部分甲瓣和第2趾胫侧皮瓣修复手指3例6指.双足第2趾甲瓣和趾腓侧皮瓣修复手指17例37指.双足部分甲瓣和双足第2趾甲瓣加股前外侧皮瓣修复手指1例4指.[结果]21例47指98块皮瓣,其中有一块皮瓣坏死,97块皮瓣全部成活,随访17例37指,随访时间6～9个月,平均8个月.36指指间关节活动均接近正常,33指指甲生长完好,外形接近正常,手指两点辨别觉5～11 mm,供区功能基本无影响.[结论]双足趾腓侧皮瓣(或部分趾甲瓣)与第2趾甲瓣(或第2趾胫侧皮瓣)一期组合瓦合修复是多个手指脱套伤较好的选择.     

吻合血管的双叶复合皮瓣瓦合修复手指套脱伤

目的 探讨手指皮肤套脱伤（或部分套脱伤）选用足部游离组织移植修复创面的新术式。方法 以第一跖背或跖底动脉、足背静脉、趾神经为蒂，切取躅趾腓侧皮瓣及第二趾背侧甲皮瓣（保留第二趾）的双叶复合皮瓣移植瓦合修复手指皮肤套脱伤。血管蒂与指总动脉、掌背静脉、指神经吻合。结果 术后6例皮瓣全部成活。随访时间为6～12个月，受区手指外形逼真，主动伸屈功能良好，两点分辨觉达5～7m。供足外形及功能正常。结论 以第一跖背或跖底动脉为蒂的躅趾腓侧皮瓣、第二趾背侧甲皮瓣双叶复合皮瓣游离移植修复手指套脱伤，是一种符合“生理性修复”的手术方法。     

带翼状皮瓣的第二趾甲瓣修复手指皮肤套脱伤

目的解决第二趾趾甲瓣在修复手指皮肤套脱伤时，因第二趾短、细，造成手指侧方及根部皮肤难以覆盖的问题。方法对5例6指皮肤套脱伤患者，根据指背、掌侧及两侧皮肤缺损的长度，设计带翼状皮瓣的第二趾趾甲瓣。手指掌侧皮肤缺损，由第二趾跖侧皮肤覆盖，一般设计与趾根同宽；第二趾腓侧因切开后套入粗大的手指后造成的皮肤缺损由第三趾胫侧趾动脉皮瓣覆盖，第二趾胫侧趾根部缺损由蹿趾腓侧趾动脉皮瓣覆盖，其余创面长度及宽度的不足由跖背皮瓣覆盖。结果术后趾甲瓣全部存活。随访3-6个月，手指屈伸功能及外形恢复满意，手指皮肤两点分辨觉为5．9mm。结论采用带翼状皮瓣的第二趾趾甲瓣修复手指套脱伤，方法可靠，疗效满意。     

第二趾甲皮瓣修复手指皮肤脱套伤术后随访报告

目的：报告第二趾甲皮瓣修复手指皮肤脱套伤术后的中长期随访结果。方法：对109例121指手指皮肤脱套伤,选用第二趾甲皮瓣或带足背皮瓣的第二趾甲皮瓣进行修复。对其中61例74指进行了2～8年（平均4年）的随访。结果：随访显示,修复后的手指外形良好,指甲生长良好,指腹饱满、指腹感觉恢复S2～S4,36指两点辨别觉达到4～7mm,65指手指屈曲功能接近正常,所有病例手指都能够完成写字、持物等动作,21指能够完成捡针的精细动作,足部供区出现并发症4例,其中2例出现两种不适的表现,并发症出现率6.5%。参照中华医学会手外科分会拇、手指再造功能评定试用标准结合足部供区情况进行评定,属优者45例52指,良者13例16指,可者3例6指,无差的病例,优良率95.1%。结论：第二趾甲皮瓣急诊修复手指皮肤脱套伤,修复的手指有指甲和丰满的指腹,可最大限度地恢复伤指的外形和功能。     

指端缺损的显微外科修复

目的 探讨手指远端各种缺损的修复方法. 方法 采用第二足趾趾动脉旋转"三叶皮瓣"修饰性再造23指:用(拇)甲瓣、半(拇)甲瓣、(拇)趾与第二足趾组织瓦合修复拇手指脱套伤33指;用(拇)趾腓侧及第二足趾胫侧皮瓣修复指腹缺损28指;(拇)趾趾甲或近侧带部分皮瓣修复指甲皮肤缺损27指.结果 临床修复98例111指,除5例出现血管危象,及时处理后恢复外,其它均一期成活,外形美观.结论 用显微外科技术修复拇手指远端的缺损,是理想的方法,达到了缺什么、补什么的理想目的 .     

第2趾胫侧皮瓣修复手指中末节指腹皮肤软组织缺损

目的探讨以跖底动脉为蒂的第2趾胫侧游离皮瓣移植修复手指中末节指腹软组织缺损或指尖皮肤缺损的临床效果。方法1998年1月一2012年3月,对29例因外伤造成手指中末节指腹软组织缺损或指尖皮肤缺损患者,采用第2趾胫侧皮瓣游离移植修复。结果本组29例均恢复原手指的外形与功能,且保留了第2趾的长度、外形与功能。结论第2趾胫侧游离皮瓣是修复手指中末节指腹软组织缺损或指尖皮肤缺损的良好方法。     

Flag flap - Kite flap Dorsal metacarpal flap

The flag flap is a pedicled dorsal digital flap, combining a skin paddle (the “flag”) and a vascular pedicle (the flag “pole”). Its vascularisation depends on the dorsal metacarpal arteries (DMCA). It has been described in 1963, by Holevitch [1] with harvest of a cutaneovascular pole; it has been brilliantly modified in 1979 by Foucher et al. [2–4] under the form of a unipedicled “kite” flap, although we would like to point out that Vilain has been using it since 1952 [5]. Usually harvested from the dorsum of the metacarpophalangeal region of the index finger, this flap is reliable, but it is more uncertain and less movable at the level of the other digits. Owing to its small size, it proves useful in hand traumatology because it does not sacrifice any major vascular axis. The kite flap is considered as a sensory flap (presence of a nerve supply) with a two-point discrimination, which can be assessed from 11 to 16 mm [1–6].     

Recycling a flap: Making a perforator flap from a previous gluteal fasciocutaneous flap

Abstract

We report a case of raising a previous gluteal fasciocutaneous flap again as a perforator-based flap to cover a recurrent defect. This case illustrates that conventional flap tissue with a preserved perforator can be recycled as a perforator flap, and that this method can be an efficient surgical option for recurrent defects.     

McGregor flap

Since it has been described in the early seventies [1], this flap has become an essential tool in reconstructive surgery, primarily due to the wide cutaneous surface it may replace. Its pediculate form is useful and it may be employed with significant benefit as free flap; it may even provide composite tissues. Also known as McGregor’s flap, groin flap, or iliofemoral flap, this axial pattern flap is based on the superficial iliac circumflex artery.     

V-Y advancement flap out of an existing flap

A case is reported in which a large V-Y flap was fashioned out of a flap already present over the dorsum of the hand, to cover a defect created adjacent to it. The V-Y advancement appeared more effective to fill the defect than the traditional method of mobilisation of a part of the flap achieved by dissecting it from its base.     

吻合血管的足底内侧及足内侧双叶皮瓣的临床应用

目的 报道游离足底内侧及足内侧双叶皮瓣修复手部皮肤缺损的手术方法及临床效果,方法,在解剖研究的基础上设计以足底内侧血管为主干,带其主干支及足内侧区皮穿支构成足底内侧非负重区,足内侧区双叶皮瓣,游离移植同时修复手或手指两处皮肤缺损。     

Recycling a flap: making a perforator flap from a previous gluteal fasciocutaneous flap

We report a case of raising a previous gluteal fasciocutaneous flap again as a perforator-based flap to cover a recurrent defect. This case illustrates that conventional flap tissue with a preserved perforator can be recycled as a perforator flap, and that this method can be an efficient surgical option for recurrent defects.     

Atasoy flap

Fingertip tissue loss is frequent. It often requires a reconstruction with a flap in case of exposure of the distal phalanx. We will present the technique of reconstruction by means of a local pedicle flap described by Atasoy. It is a local bipedicled flap harvested from the fingertip. The incision is triangular or volar without exceeding the palmar fold of the distal interphalangeal. Laterally, it is located 2 millimetres from the lateral nail folds. The flap is detached from the phalanx on its deep aspect. When the flap is released it can protrude from 5 to 7 millimetres. The flap covering the phalanx is then fixed by means of an intradermic needle and sutured laterally. The needle and the stitches are removed between the 2^nd and the 3^rd postoperative week. Physiotherapy will start the day following the surgery. There should be a relative abundance of remaining fingertip tissue so that it will be able to cover the phalanx; this technique is recommended in both the strictly transverse and dorsal oblique amputations. Among the most common undesired effects we have sensory changes, temporary pains in the fingertip pulp space and the palmar retraction of the flap if not properly fixed. However, this flap is still reliable and can be reproduced; it gives excellent cosmetic appearance if it is set correctly.