第二足趾胫侧趾腹皮瓣游离移植修复指腹组织缺损

目的 探讨应用第二足趾腹皮瓣游离移植修复拇、手指指腹软组织缺损的手术方法和临床疗效.方法 根据拇、手指指腹软组织缺损的大小、范围和形状,于同侧第二足趾胫侧趾腹设计趾腹皮瓣,皮瓣的轴线为第二足趾胫侧趾底固有动脉、神经的投影.切取皮瓣面积2.0 cm×2.3 cm～2.0 cm×3.5 cm,临床应用修复10例.结果 术后有2例皮瓣边缘少部分坏死,经换药后创面愈合外,另8例皮瓣均成活良好.术后随访4～16个月,皮瓣血运、质地、弹性良好,指腹饱满,外形满意.手指功能恢复良好.皮瓣两点分辨觉为5.0～9.0 mm.第二趾供区创面均Ⅰ期愈合,不影响穿鞋及行走.结论 游离第二足趾胫侧趾腹皮瓣手术简便,血供可靠,可重建感觉功能,是修复拇、手指指腹软组织缺损的良好方法.     

微型皮瓣修复手指指腹缺损

目的:报道六种微型皮瓣修复手指指腹缺损的临床效果.方法:急诊对52例60指手指指腹缺损患者,分别采用六种皮瓣进行修复,其中邻指皮瓣8例8指,指动脉逆行岛状皮瓣9例10指,指背神经营养筋膜皮瓣9例11指,游离尺动脉腕上皮支下行支皮瓣8例8指,游离足第二趾侧方皮瓣9例14指,游离趾腹皮瓣9例9指,并进行随访,比较临床效果.结果:本组皮瓣均一期成活,伤口均一期愈合,经过6～20个月随访(平均10个月),采用第二趾侧方皮瓣及趾腹皮瓣感觉恢复最好,2pd(两点辨别觉)4 ～ 6mm,其次游离尺动脉腕上皮支下行支皮瓣2pd7 ～ 9mm皮瓣外形、质地均比较满意.结论:带感觉神经的微型游离皮瓣是修复手指指腹缺损最为理想的手术方法,可以恢复指腹的精细感觉.     

趾腹腓侧皮瓣移植修复指腹缺损

目的　介绍游离趾腹腓侧皮瓣移植修复拇、手指腹缺损的临床效果。方法　 2 0 0 0年 9月起 ,亚急诊行游离趾腹腓侧皮瓣修复拇、手指全指腹缺损 6例。结果　 6例皮瓣全部成活 ,术后随访 3个月～ 3年 ,拇、手指外形满意 ,皮瓣两点分辨觉达 6～ 10mm ,手指活动功能良好。结论　趾腹腓侧皮瓣移植术是修复拇指指腹缺损的首选方法 ,也适用于修复示、中指指腹缺损。     

游离足底内侧皮瓣修复腕掌尺侧皮肤神经缺损

目的 探讨修复腕掌尺侧皮肤神经同时缺损的新方法.方法 2000年4月至2009年8月,应用游离足底内侧皮瓣修复腕掌尺侧皮肤并神经缺损5例.足拇趾胫侧趾底固有神经修复小指尺掌侧固有神经缺损1例;桡神经浅支修复尺神经及其深浅支缺损2例,修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例;尺神经手背支修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例.足底内侧血管与尺血管吻合.供区取同侧大腿皮片移植修复.结果 术后皮瓣及移植皮片全部成活.5例获得6个月至4年的随访,皮瓣质地好、外观满意,无手内肌萎缩和爪形手畸形,皮瓣和手指感觉恢复达S3～S3+,皮瓣两点辨距觉为7～10 mm.尺神经深浅支缺损病例术后综合评价均为优.结论 游离足底内侧皮瓣是修复腕掌尺侧皮肤神经缺损的有效方法.     

游离足底内侧皮瓣修复腕掌尺侧皮肤神经缺损

目的 探讨修复腕掌尺侧皮肤神经同时缺损的新方法.方法 2000年4月至2009年8月,应用游离足底内侧皮瓣修复腕掌尺侧皮肤并神经缺损5例.足拇趾胫侧趾底固有神经修复小指尺掌侧固有神经缺损1例;桡神经浅支修复尺神经及其深浅支缺损2例,修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例;尺神经手背支修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例.足底内侧血管与尺血管吻合.供区取同侧大腿皮片移植修复.结果 术后皮瓣及移植皮片全部成活.5例获得6个月至4年的随访,皮瓣质地好、外观满意,无手内肌萎缩和爪形手畸形,皮瓣和手指感觉恢复达S3～S3+,皮瓣两点辨距觉为7～10 mm.尺神经深浅支缺损病例术后综合评价均为优.结论 游离足底内侧皮瓣是修复腕掌尺侧皮肤神经缺损的有效方法.     

游离足底内侧皮瓣修复腕掌尺侧皮肤神经缺损

目的 探讨修复腕掌尺侧皮肤神经同时缺损的新方法.方法 2000年4月至2009年8月,应用游离足底内侧皮瓣修复腕掌尺侧皮肤并神经缺损5例.足拇趾胫侧趾底固有神经修复小指尺掌侧固有神经缺损1例;桡神经浅支修复尺神经及其深浅支缺损2例,修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例;尺神经手背支修复尺神经浅支、第4指掌侧总神经及小指尺掌侧固有神经缺损1例.足底内侧血管与尺血管吻合.供区取同侧大腿皮片移植修复.结果 术后皮瓣及移植皮片全部成活.5例获得6个月至4年的随访,皮瓣质地好、外观满意,无手内肌萎缩和爪形手畸形,皮瓣和手指感觉恢复达S3～S3+,皮瓣两点辨距觉为7～10 mm.尺神经深浅支缺损病例术后综合评价均为优.结论 游离足底内侧皮瓣是修复腕掌尺侧皮肤神经缺损的有效方法.

Abstract：

Objective To explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side. Methods From April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps.Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomozised with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg. Results All the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.Conclusions Free medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.     

第二足趾胫侧皮瓣治疗手指软组织缺损的临床分析

目的 探讨第二足趾胫侧皮瓣修复手指软组织缺损的方法和疗效.方法 自2006年起,应用第二足趾胫侧皮瓣游离移植修复手指软组织缺损30例.其中单侧第二足趾胫侧皮瓣移植21例,双侧第二足趾胫侧皮瓣移植5例,与同侧(母)趾腓侧皮瓣串联移植4例,皮瓣切取面积为6.0 cm×3.0 cm～2.0 cm×1.5 cm.结果 术后皮瓣全部存活.30例获得随访时间为6～12个月,皮瓣肤色红润,质地良好,手指外形及功能满意.按中华医学会手外科学会上肢部分功能评定试用标准评定,优良率达96%.皮瓣两点分辨觉达6～10 mm.结论 第二足趾胫侧皮瓣游离移植修复手指软组织缺损是一种理想的治疗方法.     

足拇趾甲瓣与第2趾趾骨皮瓣组合再造拇指术

目的探讨应用足拇趾甲瓣与足第2趾趾骨皮瓣组合再造拇指的临床应用价值。方法12例（13指）拇指缺损平面：Ⅰ度缺损3例3指,Ⅱ度缺损5例6指,Ⅲ度缺损2例2指,Ⅳ度缺损1例1指,Ⅴ度缺损1例1指。依据手指缺损的长度和范围设计拇趾趾甲瓣与第2足趾趾骨皮瓣切取范围,第2趾携带胫侧皮瓣。末节再造者8例9指,其拇趾供区全厚植皮,第2趾创面直接闭合;4例4指应用第2趾甲皮瓣修复拇趾趾创面。结果12例均获随访,时间28个月。再造指全部成活12指,甲床部分坏死1指。再造指感觉运动功能及外观功能满意。按赵书强手功能评定标准：优3例,良9指,可1指。足供区外观功能均满意。结论足拇趾甲瓣与第2趾趾骨皮瓣组合再造术是解决拇手指缺损的有效方法。     

应用足趾侧方游离皮瓣移植修复手指软组织缺损

目的探讨足趾侧方游离皮瓣修复手指软组织缺损的临床疗效。方法采用足趾侧方皮瓣游离移植修复42例手指皮肤缺损患者(54指)。10例采用足拇趾腓侧游离皮瓣,13例采用第2趾胫侧游离皮瓣,5例采用第3趾胫侧游离皮瓣,2例采用第4趾胫侧游离皮瓣,12例相邻2指皮肤缺损采用拇趾腓侧、第2趾胫侧游离皮瓣联合移植。结果术后皮瓣全部成活。患者均获随访,时间5～16个月。皮瓣血运、质地、弹性及手指外形良好。皮瓣两点分辨觉达5～10 mm。按中华医学会手外科学会上肢部分功能评定试用标准评定:优40指,良11指,差3指,优良率为94%。结论足趾皮瓣游离移植修复手指特定部位皮肤缺损疗效理想。     

Vascularized bone blocks from the toe phalanx to solve complex intercalated defects in the fingers

PURPOSE: Vascularized bone transplants resist infection and allow rapid healing but keeping small bony segments vascularized, as needed for a finger defect, is a challenge. The purpose of this article is to present a cohort of patients with traumatic intercalated compound bony defects in the fingers that were reconstructed by a vascularized toe phalanx (or part of a phalanx) in a single stage. METHODS: Eight patients were treated with an intercalary vascularized bone graft that included a part of the proximal phalanx (3 patients), most of the middle phalanx (4 patients), or a portion of each phalanx (1 patient) of a second toe (totaling 9 bone blocks). There was an associated soft-tissue defect in each patient, an infection in 6 patients, and cartilage loss in 4 patients. The toes were pedicled on the proper digital artery (6 patients) or a segment of the first dorsal metatarsal artery (2 patients). A mean length of 12 mm of vascularized bone was transferred. The associated skin island varied from a minimum of 2 x 1 cm to a maximum of 5 x 3 cm. Bleeding from all of the bone surfaces was evidenced once the clamps were released. The homolateral digital nerve and the contralateral neurovascular pedicle of the toe were kept in place. The toe defect was treated by soft-tissue arthroplasty or arthrodesis. No toe was amputated. RESULTS: Radiologic bony union was evident at 4 to 6 weeks, except in 1 patient with an acute infection whose distal union failed to unite at 6 weeks because the infection recurred. Finger length loss averaged 3 mm. All patients returned to their preoperative occupation. CONCLUSIONS: In this group of patients the toe phalanx reliably maintained its vascularization, allowing us to solve compound osteocutaneous defects in the fingers in a single stage. Donor site morbidity 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.     

手指皮神经营养血管皮瓣修复末节皮肤缺损

目的报道应用手指皮神经营养血管皮瓣修复末节皮肤缺损的临床疗效。方法根据手指皮神经的解剖特点,采用带指背皮神经及指固有神经背侧支的神经营养血管皮瓣修复手指末节皮肤缺损．并重建感觉37例42指。结果皮瓣全部成活,随访3～18个月,皮瓣质地柔软、弹性好、耐磨;指端饱满,色泽正常,两点辨别觉6～11mm。结论手指皮神经营养血管皮瓣是修复手指末节皮肤缺损的较好方法。     

第二足趾改形移植再造拇手指

目的 研究第二足趾改形移植方法 ,使再造后的拇手指外观更接近手指. 方法 切取第二足趾腓侧趾动脉皮瓣旋转嵌入狭窄部;在趾腓背侧设计皮瓣,在趾腓侧动脉皮瓣胫侧加设计一横形皮瓣称"T"皮瓣、在横形皮瓣的胫侧加一纵形皮瓣称"H"皮瓣.镶嵌在第二足趾的狭窄的两侧和跖侧.应用在不同形状和不同手指再造. 结果 再造17例22指,手指全部成活,1例趾动脉旋转皮瓣部分坏死,术后1～24个月随访,再造拇手指的外形明显改善,指端变小,趾腹酷似手指指腹,狭窄凹陷区饱满,趾间关节明显伸直. 结论 改形移植方法 能较好改变第二足趾的外形.使之更接近正常的拇指和手指.     

手部复合组织缺损的显微外科修复

目的 介绍吻合血管的复合组织移植或组合组织移植修复手部复合组织缺损的疗效。方法 1983年12月-2001年6月，对35例五类手部复合组织缺损进行手术治疗。采用带趾长伸肌腱的足背复合组织瓣移植修复手背皮肤缺损合并指伸肌腱缺损4例；Mu趾腓侧半复合组织瓣或第二足趾胫侧半复合组织瓣移植修复拇、手指末节半侧缺损4例；带近侧趾间关节的节段性第二趾复合组织瓣移植修复拇、手指中段部分或完全缺损8例；第二足趾与游离皮瓣组合移植为拇指缺损合并手部皮肤缺损者一期再造拇指并修复手部皮肤缺损17例；双侧第二足趾桥接组合移植再造与修复近节指骨基底水平的长手指缺损2例。结果 临床上修复组织缺损35例，成功33例。术后经半年至5年的随访，按中华医学会手外科学会上肢部分功能评定试用标准，优良率为82.9％。结论 吻合血管的复合组织移植或组合组织移植是修复手部复合组织缺损的比较理想方法。     

手背双逆行皮神经营养血管蒂皮瓣修复两手指背侧皮肤缺损

[目的]报道手背双逆行皮神经营养血管蒂皮瓣修复手指背侧皮肤缺损的方法。[方法]以桡、尺神经在手背侧的4个分支的营养血管为蒂设计各种皮瓣，同时应用其中的2种修复2个手指背侧的皮肤缺损。[结果]5例共10块皮瓣全部成活，伤指创面完全覆盖。[结论]逆行皮神经营养血管蒂皮瓣血供充分，不损伤知名血管，修复距离远，是修复手指背侧皮肤缺损的良好方法，可同时应用2个皮瓣以修复2个手指的皮肤缺损。     

拇指指腹缺损的显微外科修复

目的 探讨含感觉神经的微型皮瓣修复拇指指腹缺损的临床疗效.方法 2000年2月-2010年3月,采用食指背岛状皮瓣、中指侧方岛状皮瓣、以桡侧指动脉为蒂逆行岛状皮瓣、桡动脉掌浅支为蒂的逆行皮瓣、拇指尺背侧动脉逆行皮瓣、拇指背皮神经营养血管皮瓣、第2趾趾腹皮瓣、？？趾甲皮瓣、大鱼际部浅静脉动脉化逆行皮瓣共9种皮瓣修复重建拇指指腹缺损134例.结果 3例皮瓣坏死,131例成活,6个月～1.5年随访108例,皮瓣外形血供充分,质地柔软,感觉测定S2～S4＋,两点辫别觉6～11mm.结论 采用含感觉神经的微型皮瓣修复拇指指腹缺损,对供区影响小、效果佳、为理想的术式选择.     

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。     

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.     

游离尺动脉腕上皮支下行支皮瓣修复手指创面的应用研究

目的 研究游离尺动脉腕上皮支下行支皮瓣修复手指创面的手术方法 ,观察其临床应用效果.方法 2001年3月至2006年12月,对75例(79指)手指软组织缺损患者,采用以尺动脉腕上皮支下行支为血管蒂的游离皮瓣进行修复,其中59例(62指)采用急诊或延迟手术修复,16例(17指)采用择期手术修复.临床应用过程中观察血管是否存在变异情况.结果 术后75例(79指)皮瓣全部成活,1例皮瓣远端部分坏死,经植皮后愈合.术中发现尺动脉腕上皮支存在三种不同类型的变异,包括皮支发出位置、皮支数目、非尺动脉发出皮支三种,经过相应的手术措施,血管变异的皮瓣全部成活.所有皮瓣术后随访6～24个月,平均14个月,皮瓣质地、外形满意.重建感觉者,两点分辨觉为6～11 mm;未行感觉神经修复者,半年后皮瓣均恢复保护性感觉.手指功能恢复满意.结论 应用尺动脉腕上皮支下行支皮瓣修复手指创面,血管解剖较恒定,操作简便,术后皮瓣外形、皮肤质地及功能均较满意,可以重建感觉功能,值得临床推广应用.     

游离第二足趾胫侧皮瓣修复手指指腹缺损

目的 报告应用游离第二足趾胫侧皮瓣移植修复手指指腹缺损的手术方法和临床效果.方法 对70例76指手指指腹缺损的患者,采用游离第二足趾胫侧皮瓣进行修复,皮瓣切取面积为1.5 cm×1.0 cm～4.0 cm×2.5 cm.皮瓣的供血动脉采用第二足趾胫侧趾底固有动脉60指,采用第一跖背动脉一趾背动脉供血16指.足部供区采用全厚皮片加压植皮.结果 70例76指皮瓣全部存活,其中4指皮瓣在术后3 d内发生动脉危象,经手术探查后动脉危象解除.所有患者经过5～24个月(平均8个月)的随访,皮瓣质地、外形满意,手指功能恢复优良,远侧指间关节活动度为0°～60°,皮瓣两点分辨觉为4～9 mm.足部供区创面Ⅰ期愈合71趾,植皮中央区部分坏死5趾,经换药后愈合.远期随访植皮区耐磨,不妨碍行走,无破溃发生.结论 应用游离第二足趾胫侧皮瓣修复手指指腹缺损.具有手术操作相对简单、手术时间短、修复后的手指指腹饱满且外形逼真等优点,是一种理想的方法.