(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。     

不同构制游离组织组合移植一期修复全手脱套伤

目的 探讨应用不同构制游离组织组合移植一期修复全手皮肤撕脱伤的临床效果.方法 ①采用拇甲瓣与股前外侧皮瓣移植15例;②拇甲瓣与一侧股前外侧皮瓣和小腿皮瓣移植3例;③采用双侧第2趾再造拇、手指与股前外侧皮瓣移植14例;④采用拇甲瓣与第2趾胫侧皮瓣瓦合再造拇指和股前外侧皮瓣移植8例;⑤采用拇甲瓣加双侧第2趾移植再造拇、手指和股前外侧皮瓣移植7例;⑥双侧拇甲瓣加双侧第2趾甲瓣加双足背皮瓣加股前外侧皮瓣移植8例.结果 术后出现1例皮瓣危象和1例双侧再造示、中指动脉危象经积极处理后成活,其余均成活.本组获随访6个月～9年,再造拇、手指对指,对捏,生活自理,手指两点辨别觉8～13 mm.结论 采用不同构制游离组织组合移植一期修复全手脱套伤术后功能恢复良好,是其他方法难以替代的.     

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 .     

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.     

拇手指末节部分缺损的修复与再造

目的报道应用吻合血管的足趾游离移植修复与再造拇、手指末节部分缺损的临床效果。方法采用吻合趾-指动、静脉的第二足趾游离移植或趾皮瓣游离移植修复与再造拇、手指末节部分缺损45例45指，其中：游离第二足趾12例、躅趾腓侧皮瓣游离移植4例、躅趾趾腹皮瓣游离移植3例、第二足趾胫侧皮瓣游离移植6例、第二足趾趾腹皮瓣游离移植5例、躅甲瓣游离移植3例、趾甲瓣游离移植7例、趾甲瓣加伸肌腱复合组织移植游离移植5例。结果术后45例全部成活，得到随访41例，外形满意，功能较好。结论拇、手指末节部分缺损采用足趾移植的方法进行修复与再造可获比较满意效果。     

足趾移植拇指与手指再造的临床研究

目的探讨足趾移植拇指与手指再造的方法和疗效。方法采用部分坶趾移植拇指部分再造22例,躅甲瓣或带足背皮瓣船甲瓣移植拇指再造13例,第2足趾移植再造拇指4例,再造手指3例,及带足背皮瓣的第2足趾移植再造拇指7例,带足背皮瓣的第2,3足趾移植再造手指7例,带足背皮瓣的躅甲瓣或第2趾和第2,3趾组合移植再造拇手指10例,双足第2足趾移植全手缺失二指再造2例,共68例97指。结果再造拇手指和皮瓣全部成活,成活率为100％,术后经3月～10年的随访和信访,按中华医学会手外科学会拇、手指再造功能评定试用标准评定：优62指,良24指,可9指,差2指,优良率达88．66％。结论采用部棚趾、第2足趾棚甲瓣移植再造拇手指,带足背皮瓣的躅甲瓣、第2趾或第2,3趾组合移植行合并手部皮肤缺损的拇手指再造,效果满意。     

(足母)趾背侧甲皮瓣联合第二趾胫侧皮瓣的应用及供区的处理

目的 探讨(足母)趾背侧甲皮瓣联合第二趾胫侧皮瓣的应用及供区更好的处理方法。 方法 应用(足母)趾背侧甲皮瓣联合第二趾胫侧皮瓣修复拇手指创面后用第二趾剔骨甲皮瓣转位修复(足母)趾供区16例,其中拇、示指7例,拇、中指6例,拇、环指3例,拇指均为末节背侧甲床及部分皮肤缺损,示、中、环指为指腹缺损。 结果 术后随访6 ～43个月,皮瓣全部成活,拇手指皮瓣颜色红润、质地柔软、外形饱满,两点辨别觉5 ～8mm,足部外形良好、功能无影响。 结论 (足母)趾背侧甲皮瓣联合第二趾胫侧皮瓣修复拇手指创面后应用第二趾剔骨甲皮瓣转位修复(足母)趾创面是处理受区及供区较为理想的方法。     

趾尖移植再造指尖

足趾或手指的指 (趾 )甲中部以远部分称为指尖。 1998年 9月～ 2 0 0 1年 3月 ,我们行手指指尖再造 11例 ,取得较好的效果。1.临床资料 :共 11例 11指 ,男 9例 ,女 2例。年龄 2 9～ 15岁 ,平均 19岁。拇指指尖再造 6例 ,手指指尖再造 5例。切取趾尖再造拇、手指指尖 9例 ,切取第 2趾趾尖再造手指指尖 2例。按伤指情况 ,在趾甲中分以远或第 2趾近侧甲襞以远设计带部分末节趾骨的趾甲瓣 ,趾胫侧或第 2趾腓侧保留一舌形瓣在足趾上 ,趾趾尖腓侧或第 2趾趾尖胫侧向近端设计一个三角型皮瓣。趾趾尖切取时 ,先在趾背部解剖趾背静脉 ,向近…     

第一趾蹼周围组织瓣修复手部软组织缺损

目的 探讨应用不同构置的第一趾蹼周围组织瓣修复手部组织缺损的疗效. 方法 手部软组织缺损14例,其中拇指皮肤脱套3例,示指脱套2例,中指脱套2例,示指掌桡侧皮肤缺损2例,拇指指腹缺损2例,虎口区不规则皮肤缺损1例,示指近指间关节缺损伴指背皮肤缺损1例,中指近节指骨基底缺损伴桡背侧皮肤缺损l例.分别应用(躅)甲瓣、第二趾甲瓣、第二趾胫侧皮瓣、(躅)趾腓侧皮瓣、第一趾蹼皮瓣游离移植,覆盖创面. 结果 1例发生动脉危象,经手术探查后恢复.术后随访24 ～ 36个月,皮瓣外观佳,质地软,功能良好,拇指、手指指腹两点分辨觉达4～7 mm.术后供区行走无影响. 结论 第一足背动脉系列皮瓣可满足不同形状的手部软组织缺损.     

(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.     

Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers

Surgical procedure of great toe wrap-around flap combined with second toe medial flap free transfer for reconstructing completely degloved fingers was introduced. The treatment outcomes were evaluated. 10 fingers in 7 cases were involved in this series. The great toe wrap-around flap with dorsalis pedis skin covered the dorsal and most palmar side of the injured finger. The second toe medial flap covered the proximal palmar portion of the finger. The combined flap was revascularized with nerve repair. Rehabilitation started two weeks postoperatively. All flaps survived except one was partial failure due to distal phalange necrosis. Recipient areas achieved primary wound healing in 9 fingers. Skin graft at donor site achieved primary survival except delayed healing in one case. All patients were followed-up from 34 to 76 months. The appearance of reconstructed fingers was satisfactory. Nail growth well except that one nail was the atrophic and another was defect. Range of active motion in the metacarpophalangeal joint was from 60° to 80° and the proximal interphalange joint was 40° to 70°. Two-point discrimination was between 8 mm and 12 mm. All patients walked with no interference. There was no pain and no swelling at donor site. According to the results, this procedure is recommended to reconstruct total degolving finger which has intact phalanges and tendons.     

Combined great toe dorsal nail-skin flap and medial plantar flap for one-stage reconstruction of degloved finger

BackgroundHistorically, the degloved finger with the total loss of nail and skin had been resurfaced with an expanded great toe wrap-around flap transfer for better outcomes. The purpose of this study aims to present our experience with a related modified design, with total preservation of a weight-bearing plantar skin.MethodFrom April 2016 to September 2019, nine fingers (5 index and 4 middle fingers) in nine cases, with skin loss to the base of the proximal phalangeal or metacarpophalangeal (MCP) joint level, were reconstructed with combined great toe dorsal nail-skin flap and medial plantar artery perforator (MPAP) flap. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. The cutaneous nerves were preserved within both flaps. Standardized assessment of outcome in terms of sensory, functional, and esthetic performance of the reconstructed fingers was completed.ResultsFlap survival was achieved in all cases. The contour of the reconstructed digits was comparable with the contralateral one. The fingers were available for a mean follow-up of 28 months (ranged, 22-39 months). The mean dimension of the great toe dorsal nail-skin flap was 8.5 × 4.0 cm (ranged, 6.5 × 3.5-11.0 × 4.5 cm). The average size of the MPAP flap was 6.5 × 4.5 cm (ranged, 5.0 × 3.5-8.0 × 5.5 cm). At the last follow-up, the functional and aesthetic consequences were satisfactory, as well as the restored sensory.ConclusionReconstruction of degloved fingers with the great toe dorsal nail-skin flap combined MPAP flap, preserving a plantar weight-bearing area, results in excellent contour and functional outcome. Donor-site morbidity in the foot was minimal.     

第三趾胫侧趾动脉皮瓣联合第二足趾移植改善再造手指外形

目的 探讨携带第三趾胫侧趾动脉皮瓣弥补第二足趾移植时因足趾趾腹膨大、趾体狭细而导致的外形缺陷.方法 对9例10指拇、手指缺损的患者,在第二足趾移植再造拇、手指的同时,于第三趾胫侧设计并切取趾动脉皮瓣,嵌插于第二足趾中末节跖侧,增加第二足趾的周径使其接近正常拇、手指周径,同时修整趾腹,使再造拇、手指外形更接近正常.方果 术后9例10指再造拇、手指全部存活,再造指中段周径增加了6～8mm,外形明显改善.方论 第三趾胫侧趾动脉皮瓣血管恒定,切取方便,厚度适中;于第二足趾移植再造拇、手指时可一并切取,修饰第二足趾的外形,弥补再造拇、手指的外形缺陷.     

拇甲瓣移植再造拇指术后的感觉功能恢复

目的研究拇甲瓣再造拇指术后的感觉功能恢复情况。方法2003年1月-2009年6月共行19例坶甲瓣移植再造拇指术．感觉功能的测量：行健侧坶趾趾尖及健侧对应指尖感觉功能测量．与术后指尖感觉功能测量的结果相比较,包括温度觉、痛觉、触觉、振动觉、两点辨别觉。结果术后随访12~58个月,平均26个月,皮瓣全部成活,指体外形满意,手指活动功能优良;感觉功能恢复结果：温度觉恢复最好,痛觉其次,触觉和振动觉达到正常70％;两点辨别觉恢复最差,两点辨别觉：健侧指尖（3．0±1．0）mm,健侧坶趾趾尖（6．5±2．5）mm,再造拇指术后指尖（9．0±5．0）mm。结论坶甲瓣再造拇指,外形逼真,功能优良;再造手指感觉功能恢复总体满意,但不完全并有选择性,再造手指的感觉功能更接近足趾而非手指。     

游离足趾和甲瓣移植再造拇手指42例

目的：介绍临床应用游离足趾、甲瓣移植再造拇手指的实践经验。方法：１９８８年起，应用游离足趾、甲瓣及姆甲瓣加第２跖趾关节联合移植等多种方法，再造拇手指４２例４５指。结果：除１例失败外，其余全部成活，成活率达９８％（４４／４５）。 ２３例经 １～２年随访，患者对再造拇手指的运动、感觉和外形，自我满意率达７８．３％（１８／２３）。结论：在选择再造拇指的术式时，如游离足趾、甲瓣、跖趾关节或带足青复合组织瓣移植等，应考虑到缺损手指数目、残端条件及工作性质等综合因素后，才能作出合理的手术方案。     

多角形姆趾腓侧皮瓣塑形第二足趾中段再造拇手指

目的 探讨多角形姆趾腓侧皮瓣塑形第二足趾再造拇、手指的效果.方法 切取第二足趾的同时游离并切取四角或八角形带翼状组织瓣的姆趾腓侧皮瓣,将姆母趾腓侧皮瓣嵌入第二足趾跖侧,多角形姆趾腓侧皮瓣分别嵌入第二足趾趾腹侧的相应位置,翼状组织瓣嵌入两角之间的皮下.方果 再造10例11指全部存活,嵌入的姆趾腓侧皮瓣也全部存活.术后随访时间为3～12个月,再造拇、手指的外形较传统方法移植的第二足趾有不同程度的改善,外形与健侧的拇、手指接近.方论 多角形姆趾腓侧皮瓣嵌入第二足趾,不仅改善了第二足趾中部的狭细外形,也改善了第二足趾的屈曲畸形.     

带趾间关节(足母)甲瓣修整再造拇指Ⅱ、Ⅲ度缺损

目的 探讨应用带趾间关节甲瓣再造拇指Ⅱ、Ⅲ度缺损的方法.方法 对12例12指按常规切取甲瓣,对趾趾间关节进行修整作为再造拇指的骨关节支架,以获得外观和功能满意的再造指.结果 12指全部存活,再造拇指外形逼真,感觉定位准确,功能良好.结论 带趾间关节 甲瓣再造拇指Ⅱ、Ⅲ度缺损,可获得与正常拇指基本相同的再造拇指,但需牺牲足部趾.     

改良游离母甲皮瓣移植再造拇指

目的探讨改良的拇甲皮瓣移植再造拇指的方法，以减少对供足的损害。方法2001年11月至2003年10月，应用作者设计的改良游离拇甲皮瓣移植再造拇指11例，其中6例为Ⅱ类A区缺损，5例为Ⅱ类B区缺损。在同侧拇趾切取拇甲皮瓣，皮瓣的神经血管蒂同传统的蹲甲皮瓣；将保留于供趾上的皮瓣设计于跖底负重区，其内包含跖底胫侧固有动脉和神经。结果术后随访6个月～2年，再造拇指全部存活，外形功能与传统拇甲皮瓣再造拇指的结果相当。10例患者顺利保留了供趾的全长或大部分，1例患者供趾保留的皮瓣部分坏死，作二期手术处理。11例的供足无疼痛，无磨损或破溃，步态正常。供足的静态负重，动态力学分布与对侧正常足基本相同。结论改良设计的拇甲皮瓣再造拇指，在不增加手术难度，不降低再造拇指质量的情况下，能很好的保留了供趾的功能。     

Thumb reconstruction with a wrap-around free flap according to the level of amputation

In 1980, Morrison and O'Brien reported their experiences with the reconstruction of an amputated thumb using a wrap-around neurovascular free flap from the great toe, but its indication has been limited distal to the metacarpophalangeal (MP) joint (Morrison et al., J Hand Surg 5:575-583, 1980). We have performed 37 wrap-around free flaps from the great toe for the reconstruction of thumbs amputated at distal or proximal to the MP joint and investigated their functional results according to the level of amputation. The amputation was distal and proximal to the MP joint in 25 and 12 cases, respectively. Pinching and grasping power, two-point discrimination, and the amount of opposition to the other fingers were compared to the uninjured hand. Pinching and grasping power were not significantly different according to the level of amputation but the results of two-point discrimination was better in the cases amputated proximal to the MP joint. The opposition of reconstructed thumb to the other fingers was completely possible in all cases amputated distal to the MP joint. In the 12 cases amputated proximal to the MP joint of the thumb, opposition was completely possible in 6 cases in which the iliac bone block was fixated in the position of 30 degrees flexion and 45 degrees internal rotation. However, in the other six cases in the fixation of 30 degrees flexion and 30 degrees internal rotation, the opposition of the reconstructed thumb to the ring and little fingers was impossible in five cases and only to the little finger in one case. In this study, we concluded that amputation proximal to the MP joint is not an absolute contraindication to the wrap-around free flap procedure for thumb reconstruction. However, for a better functional outcome, we recommend iliac bone block fixation in the position of 30 degrees flexion and 45 degrees internal rotation.     

重视再造拇指及供足外观的(足母)甲皮瓣移植

目的 在提高(足母)甲皮瓣移植再造拇指功能的基础上进一步改善外形,减少对供足的损害.方法 对39例拇指缺损的患者,采用Morrison及改良(足母)甲皮瓣方法移植再造拇指,供区创面修复采用游离植皮30例、皮瓣加游离植皮8例、皮瓣1例.结果 移植(足母)甲皮瓣39例,存活38例,失败1例.术后随访3个月至2年,再造拇指均有不同程度的直径缩小、皮肤变薄、指纹变浅现象,萎缩以指甲部最为明显.指腹两点分辨觉平均为10mm.(足母)趾创面4例需再次植皮或咬除部分趾骨,缝合后愈合;其余创面全部愈合.3个月内大多数患者行走时感到轻度疼痛;随访半年以上者疼痛逐渐消失,站立、行走、跑步均无明显异常.结论 (足母)甲皮瓣移植术中注意骨骼的设计、甲床的切取及多根神经的缝接,术后可明显改善再造拇指的外形.改良(足母)甲皮瓣的切取方法能减少对供区功能的损害,改善外观.