足趾移植再造手指术后外形的整形

目的 探讨足趾移植再造手指术后外形的整形方法.方法 自2002年至今,对手指缺损采用第二足趾移植再造手指术后,伴有指腹、指体、指甲畸形的65例77指,联合应用骨、肌腱、局部皮瓣等显微外科方法,整形再造指的外形.结果 术后再造指外形都得到一定的纠正,再造指外形满意,功能改善.术后再造指感觉无影响.结论 足趾移植再造手指术后指腹、指体、指甲的外形畸形,通过显微外科技术进行整形能改善其外形和功能.

Abstract：

Objective To explore the methods of correcting malformation of reconstructed fingers in toe-to-hand transfer. Methods In a series of 77 reconstructed fingers in 65 cases of second toe-to-hand transfer since 2002,deformities of finger pulp,shaft or fingernail were present. Plastic interventions included inserting local fasciocutaneous flap and adjusting the bone and tendon of the reconstructed fingers with microsurgical techniques. Results The deformities were corrected and outward appearance was improved. Function of the fingers was improved while the sensation was not compromised. Conclusion Plastic intervention using microsurgical techniques to correct malformation of finger pulp,body and fingernail can improve the appearance and function of reconstructed fingers.     

改良掌背动脉穿支皮瓣修复手指软组织缺损

目的 探讨吻合皮神经改良掌背动脉穿支皮瓣修复手指软组织缺损的方法及临床疗效.方法 2005年1月至2008年3月收治31例38指软组织缺损患者,男26例31指,女5例7指;年龄14～66岁,平均29.6岁.其中示指11指,中指18指,环指6指,小指3指.31例中9例伴肌腱断裂(伸肌腱断裂6例,屈肌腱断裂3例),其中伸肌腱缺损3指;伴中节指骨骨折5例.缺损范围为1.0cm×0.8 cm～3.2 cm×2.5 cm.缺损平面均位于近侧指间关节以远,应用不带掌背动脉全长的掌背动脉远端穿支逆行岛状皮瓣修复,皮瓣血管蒂的旋转点由传统指蹼游离缘近侧1.5 cm背侧改至掌侧,并吻合指背神经.皮瓣切取范围1.2 cm×1.0 cm～3.5 cm×2.8 cm.供区直接缝合或游离植皮.结果 术后3例皮瓣远端出现张力性水疱表皮结痂,经换药后愈合;其余皮瓣顺利成活,皮瓣及供区切口均Ⅰ期愈合.28例35指术后获3～25个月(平均15.3个月)随访.皮瓣质地柔软,外观饱满.两点辨别觉为6～9 mm,平均7.7 mm.术后8个月,手功能按手指总主动活动度法评定:优20指,良13指,可2指,优良率为94.3%.结论 吻合皮神经改良掌背动脉远端穿支逆行岛状皮瓣移植修复手指软组织缺损,疗效满意,是一种较好的方法.

Abstract：

Objective To report operative procedures and clinical results of repairing finger soft tissue defects with a modified reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery. Methods From January 2005 to March 2008,we repaired 38 finger soft tissue defects in 31 patients (26 men and 5 women) with a modified reversed island flap pedicled on a distal perforating branch of the dorsal metacarpal artery and anastomosis of the cutaneous nerve.Their ages ranged from 14 to 66 years,with a mean of 29.6 years.Altogether 11 index,18 middle,6 ring and 3 little fingers were injured.Nine patients were complicated with rupture of tendons,3 with extenso-tendon defects and 5 with middle phalanx fractures.The defect areas ranged from 1.0 cm × 0.8 cm to 3.2 cm× 2.5 cm.The flap areas ranged from 1.2 cm× 1.0 cm to 3.5 cm× 2.8 cm.The flap did not carry a full length of the dorsal metacarpal artery but only the distal perforating branch of the artery.The rotating point of the flap pedicle was altered from the dorsal to the palmar side to extend the vessel pedicle.The donor sites were closed by suture or skin graft. Results Twenty-eight patients (35 fingers) were followed up for 3 to 25 months (mean,15.3 months) .All flaps survived with satisfactory appearance,sensation and function.All flaps and donor sites obtained primary healing.The two-point discrimination was 6 to 9 mm (mean,7.7 mm).According to Total Active Movement (TAM) evaluation system,the results were excellent in 20,good in 13 and fair in 2 fingers,with a good to excellent rate of 94.3％. Conclusion The modified reversed island flap pedicled on a distal perforating branch of the dorsal metacarpal artery and anastomosis of the cutaneous nerve is an easy,safe and effective treatment for finger soft tissue defects.     

趾动脉终末支岛状皮瓣结合压力治疗重塑再造指外形

目的 探讨趾动脉终末支岛状皮瓣结合压力治疗重塑再造指外形的方法及临床疗效.方法 自2009年3月至2011年3月,对9例9指手指缺损的患者采用足趾趾动脉终末支岛状皮瓣转移嵌入第2趾颈部,修复因该部位狭窄导致的外形缺陷,术后2周再造指采用压力套给予24h的压力治疗.结果 9例患者再造9指全部成活,嵌入趾颈部狭窄处的皮瓣均Ⅰ期成活,术区伤口及供区足部伤口均Ⅰ期愈合.9例患者获随访5～16个月,再造手指外形得到明显改善,指腹与指颈部及指-趾结合部过渡自然.再造指屈伸功能恢复,指腹感觉恢复至S1～S3,效果较满意.结论 应用趾动脉终末支岛状皮瓣结合压力治疗重塑再造手指外形,解决了再造指"指腹"膨大和掌侧"颈部"狭窄的外形缺陷,且外形过渡自然,临床疗效较好.     

Reconstruction of finger pulp defect with reversed fasciocutaneous island flap from same finger

Objective:To investigate the clinical curative effect of reconstruction of finger pulp defect by anastomosis of reversed fasciocutaneous island flap with dorsal branch of the digital nerve of the same finger. Methods: The restoration of finger pulp defect with fasciocutaneous island flap from the same finger was conducted in 25 cases (30 fingers) from January 2002 to June 2003. Nine patients (11 fingers) whose flaps with dorsal branch of the digital nerve anastomosed with the digital inherent nerve around the surface of the wound were Group A and the others were Group B. The follow-up was carried out at 3 and 9 months after the operation to observe the shape of finger pulp and the sense restoration between two groups. Results: All flaps of 25 cases (30 fingers) survived. Three months after operation, the patients had fully grown finger pulps and recovered the superficial sensation and tactile sense of finger pulps. The two point discrimination on average was 5. 00 mm±0. 23 mm in Group A and 6.00 mm±0.30 mm in Group B. The difference between two groups was highly significant. Nine months later, their senses of finger pulps between two groups were recovered basically. Conclusions: The reversed fasciocutaneous island flap from the same finger is the first choice to reconstruct the finger pulp defect, and the anastomosis of dorsal branch of the digital nerve shall be determined according to the specific condition.     

足背动脉逆行岛状筋膜瓣联合植皮在甲皮瓣切取后创面修复中的应用

目的 报告应用足背动脉逆行岛状筋膜瓣联合植皮修复甲皮瓣切取后创面的方法及临床疗效.方法 对8例拇指套脱伤应用甲皮瓣移植修复后,供区创面缺损面积最大为3.5 cm×6.8 cm,最小为2.5 cm×4.9 cm.以足背动脉足底穿支为旋转点,足背动脉体表投影为轴线,在踝前设计足背动脉岛状筋膜瓣,切取足背动脉周缘筋膜组织,结扎足背动脉近端分支,逆行转移至趾切取后的创面,并在筋膜上植全厚皮片、不打包.结果 8例甲皮瓣、筋膜瓣及植皮创面全部存活,对足部血供无影响.术后随访时间为3～18个月,修复后的趾保留正常长度,外形良好,植皮区无挛缩,恢复保护性感觉,趾屈伸活动及下肢行走正常.结论 足背动脉逆行岛状筋膜瓣切取简单,便于旋转,血供丰富,且保留了趾的长度,是修复甲皮瓣切取后遗留创面理想的修复方法.

Abstract：

Objective To report the method and clinical outcomes of covering big toe defects after wrap-around flap transfer with dorsalis pedis artery reversed fascial island flap combined with skin graft. Methods Wrap-around flap transfer was used to reconstruct degloved thumbs in 8 cases,which left soft tissue defects of the big toe ranging from 2.5 cm×4.9 cm to 3.5 cm×6.8 cm. The reverse fascial island flap pedicled by the dorsalis pedis artery was designed at the anterior ankle with the plantar perforator as pivot point and the surface projection of dorsal pedis artery as axis. The fascia around the dorsalis pedis artery was included in the flap. Proximal branches of the dorsalis pedis artery were ligated and the flap was lifted and rotated to cover the big toe defect. Full-thickness skin was grafted on top of the fascial flap. Results All flaps and skin grafts survived. Blood supply of the foot was not compromised. Postoperative follow-up ranged from 3 to 18 months. The length of the donor big toes was preserved. The contour of toes repaired by flaps was good. There was no contracture of skin grafts. Protective sensation was restored. Walking and motion of the toes was normal. Conclusion Dorsalis pedis artery reversed fascial island flap is easy to harvest and rotate. It has rich blood supply. Transfer of this flap can preserve the length and contour of the big toe and therefore is an ideal method to cover donor site defects left by wrap-around flap harvest.     

利用一个足趾游离移植同时修复两个手指组织缺损

目的 探讨利用一个足趾游离移植同时修复两个手指组织缺损的临床效果.方法 采用同一个足趾两个部分游离移植,同时修复两个手指关节复合组织或手指缺损,临床应用4例8指,其中2例用第二足趾的末节再造示指的末节或指尖,同时用第二足趾的近趾间关节组织块修复中指的近指间关节组织缺损;1例用第二足趾的远趾间关节和近趾间关节组织块同时再造示、中指的近指间关节:1例用第二足趾的近趾间关节和跖趾关节组织块同时再造示、中指的掌指关节.结果 术后再造组织全部成活,随访2～46个月,手部的功能外观满意,关节活动良好,无疼痛,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,有2指为优,5指为良,1指为可.结论 对于同时合并两个手指的末节、指间关节或掌指关节缺损的病例,本手术是一种较好的修复方法.

Abstract：

Objective To investigate the outcome of the finger reconstruction using one toe transfer to repair the tissue defects of two fingers at the same time. Methods Two fingers joint tissue missing and finger defect of 8 fingers in 4 cases were reconstructed with dissociative transplants harvested from two parts of the same toe at the same time.Using the paratelum of the second toes reconstructed the indicis paratelum or finger tip,and using the proximal interphalangeal joint of the second toes repaired the proximal interphalangeal joint's tissue defects of the middle finger at the same time in 2 cases.Using the distal interphalangeal joint and the proximal interphalangeal joint of one second toe reconstructed the proximal interpha langeal joints of the index finger and the middle finger in 1 case.Using the proximal interphalangeal joint and the metatarsophalangeal joint of one second toe reconstructed the metacarpophalangeal joints of the index finger and the middle finger in 1 case. Results All the transplants survived.The patients were followed-up from 2 months to 46 months postoperatively.The function and shape of 2 resconstruction fingers were excellent as assessed with Criterion on Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery.Five resconstruction fingers were good.One resconstruction finger was fire. Conclusion For some appropriate cases with the tissue defects of 2 fingers such as the finger's paratelum,the interphalangeal joint or the metacarpophalangeal joint,this operated technique was a good method.     

改良第二掌背动脉皮瓣修复示中指中末节套脱伤

目的 探讨应用第二掌背动脉(second dorsal metacarpal artery,SDMA)逆行岛状皮瓣修复示、中指中末节皮肤套状撕脱伤的方法及疗效.方法 2004年5月至2010年1月,收治17例示指或中指中末节皮肤套状撕脱伤患者.采用SDMA岛状皮瓣进行修复,并缝合指背神经.皮瓣切取面积为2.5 cm×5.6 cm～5.0cm×6.5 cm,供区创面行游离植皮.结果 术后2例皮瓣远端出现张力性水泡,表皮结痂,经换药后愈合;其余皮瓣顺利存活.皮瓣及供区植皮切口均Ⅰ期愈合.术后17例获得4～27个月的随访,平均15.3个月.皮瓣质地柔软,外观饱满无臃肿.两点分辨觉为7～11 mm,平均8.6 mm.手功能按手指总主动活动度(total active movement,TAM)法评定:优8指,良7指,可2指;优良率为88.2%.结论 缝合指背神经的改良SDMA逆行岛状皮瓣,皮瓣切取面积足够覆盖示、中指中末节套状撕脱伤皮肤缺损创面,皮瓣血运可靠,手术安全,是一种较好的手术方法.

Abstract：

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.     

指动脉远侧指间关节皮支蒂指侧方岛状皮瓣修复指端软组织缺损

目的 探讨以指动脉远侧指间关节皮支为蒂指侧方岛状皮瓣修复同指指端软组织缺损的临床效果.方法 2009年6月至2010年3月,对15例15指手指远侧指间以远的指端缺损的患者,采用以指动脉远侧指间关节皮支为蒂指侧方岛状皮瓣转移修复,术中切取皮瓣范围1.2 cm×0.8 cm～2.0 cm × 3.0 cm,供区取前臂全厚皮片移植修复.结果 15例15指术后获得随访10例10指,时间为6～12个月,皮瓣和移植皮片全部顺利成活,皮瓣质地柔软,外观满意,颜色与周围皮肤接近,顺行推进岛状皮瓣的两点辨距觉为5～6 mm,逆行岛状皮瓣的两点辨距觉为7～10 mm,远侧指间关节屈伸活动无明显障碍.手功能ATM法评定,优8指,良1指,可1指.结论 应用该皮瓣修复指端软组织缺损,不损伤指动脉和指神经,简化了传统的指根部岛状皮瓣的手术,是一种较好的方法.

Abstract：

Objective To investigate the repair of soft tissue defect at finger tip with square island flap pedicled with skin perforator of digital artery on the distal interphalangeal joint( DIP). Methods From Jun. 2009 to Mar. 2010, 15 cases with soft tissue defects at 15 fingers tip were treated with this island flaps. The flap size ranged from 1. 2 cm × 0. 8 cm to 2. 0 cm × 3. 0 cm. The defects at donor sites were covered with skin grafts from forearm. Results All the flaps and skin grafts survived. 10 fingers in 10 cases were followed up for 6-12 months. The color, texture and contour of the flaps were good. The twopoint discrimination distance was 5-6 mm on the directed island flaps, and 7-10 mm on the reverse island flaps. No obvious functional problem was found in DIP motion. The hand function was assessed as excellent in 8 fingers, good in 1 finger and medium in 1 finger. Conclusions The main artery and nerve will not be sacrified when the island flap is used. The operative procedures are easily performed for the treatment of fingertip skin defect.     

改良第二掌背动脉皮瓣修复示中指中末节套脱伤

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.     

改良第二掌背动脉皮瓣修复示中指中末节套脱伤

Objective To investigate the operative procedure and the clinical results of the modified reversed island flap based on the second dorsal metacarpal artery (SDMA) for repairing index or long finger degloving defects.Methods From May 2004 to January 2010, circumferential soft tissue defect in the middle and distal phalanx of the index or long fingers in 17 patients were repaired by the modified reversed island flaps based on SDMA.The dorsal digital nerve in the flap was coapted to the severed proper digital nerve.The area of the flaps ranged from 2.5 cm × 5.6 cm to 5.0 cm × 6.5 cm.The donor sites were closed by skin graft.Results Postoperatively blister and necrosis of the distal flap occurred in 2 cases which was cured by dressing change.All the other flaps survived uneventfully.Primary healing of the flaps and donor sites was achieved.All 17 patients were follow-up for 4 to 27 months with an average of 15.3 months.The flaps were pliable, full but not bulky.Two-point discrimination was 7 to 11 mm (mean 8.6 mm).Hand function as judged by the total active range of motion of the fingers was excellent in 8 fingers, good in 7 fingers and fair in 2 fingers.The satisfactory rate was 88.2%.Conclusion Modified SDMA reversed island flap transfer with dorsal digital nerve coaptation is an ideal procedure to repair index or long finger degloving injuries.The area of the harvested flap is large enough to cover the circumferential soft tissue defect in the middle and distal phalanx.The surgery is safe due to the reliable flap circulation.     

第二足趾再造手指外形的重塑整形

目的 比较三种不同方法重塑第二足趾再造手指外形的疗效.方法 2003年4月-2008年1月,对31例第二足趾再造手指,分别采用三种不同方法重塑再造指外形.其中7例一期采用再造指局部三角皮瓣转移;9例一期采用邻趾侧方皮瓣转移嵌入再造指指腹颈部;15例二期采用再造指指腹侧方梭形切除术.结果 术后31例再造手指全部存活.16块转移皮瓣,除1块邻趾侧方皮瓣部分坏死,经二期换药后愈合外,其余转移皮瓣均存活.经8～15个月的随访,一期整形的再造指外形明显改善;二期整形的再造指指腹膨大得到明显改善,但指腹颈部的狭窄没有改善.所有再造指感觉均恢复,两点分辨觉为6～11mm. 结论一期行再造指局部三角皮瓣转移重塑外形,同时改善了再造指指腹膨大和掌侧颈部狭窄的外形缺陷,是改善再造指外形的较好方法.     

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.     

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.     

Free second toe one-stage-plasty and transfer for thumb or finger reconstruction

Free second toe transfer has become a popular method for the management of thumb or finger reconstruction. However, this creates an obvious appearance defect. A new operating procedure has been used since 1999. To enlarge the perimeter of the reconstructed thumb, a composite tissue strip flap from the fibular of great toe pedicled with the fibular proper plantar digital artery, combined or not with the island dorsal index finger flap, was inlaid with the second toe at the same time before the reconstruction. A crescent double-winged dorsal metatarsus flap, connected with second toe, in combination with the partial metatarsal bone, was also used to reconstruct fingers. There were 36 patients in the study group with a follow-up time of 6 months to 3 years. The thumb and finger reconstructed in this way showed better appearance, with normal caliber and length and without obvious adverse affects. This method has ameliorated the embarrassing appearance of the reconstructed thumb with earlier methods and is a relatively ideal method for thumb or finger reconstruction.     

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.     

第二趾趾端复合组织串联趾侧方皮瓣修复指端缺损

目的 探讨第二趾趾端复合组织串联趾侧方皮瓣瓦合修复指端缺损的临床疗效.方法 对16例拇、手指指端复合组织缺损的患者,设计以趾底固有动脉-甲皱襞血管筋膜蒂为血管蒂的第二趾趾端复合组织,串联趾侧方皮瓣进行瓦合修复.结果 术后16例皮瓣全部存活,随访时间为4～17个月,平均12个月.手指功能恢复优良,皮瓣两点分辨觉为4～9 mm,外观逼真,指甲生长外形良好.供区趾甲生长良好,趾端无疼痛,植皮无破溃发生.结论 应用第二趾趾端复合组织串联趾侧方皮瓣修复手指指端缺损,受区外形好,供区损伤小.     

第二趾趾端复合组织串联趾侧方皮瓣修复指端缺损

目的 探讨第二趾趾端复合组织串联趾侧方皮瓣瓦合修复指端缺损的临床疗效.方法 对16例拇、手指指端复合组织缺损的患者,设计以趾底固有动脉-甲皱襞血管筋膜蒂为血管蒂的第二趾趾端复合组织,串联趾侧方皮瓣进行瓦合修复.结果 术后16例皮瓣全部存活,随访时间为4～17个月,平均12个月.手指功能恢复优良,皮瓣两点分辨觉为4～9 mm,外观逼真,指甲生长外形良好.供区趾甲生长良好,趾端无疼痛,植皮无破溃发生.结论 应用第二趾趾端复合组织串联趾侧方皮瓣修复手指指端缺损,受区外形好,供区损伤小.     

第二趾趾端复合组织串联趾侧方皮瓣修复指端缺损

目的 探讨第二趾趾端复合组织串联趾侧方皮瓣瓦合修复指端缺损的临床疗效.方法 对16例拇、手指指端复合组织缺损的患者,设计以趾底固有动脉-甲皱襞血管筋膜蒂为血管蒂的第二趾趾端复合组织,串联趾侧方皮瓣进行瓦合修复.结果 术后16例皮瓣全部存活,随访时间为4～17个月,平均12个月.手指功能恢复优良,皮瓣两点分辨觉为4～9 mm,外观逼真,指甲生长外形良好.供区趾甲生长良好,趾端无疼痛,植皮无破溃发生.结论 应用第二趾趾端复合组织串联趾侧方皮瓣修复手指指端缺损,受区外形好,供区损伤小.     

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.     

第二、三趾联合局部转移皮瓣整形第二趾再造拇手指

目的 介绍以第二、三趾联合局部转移皮瓣整形第二趾再造拇、手指的新方法.方法 对26例再造拇、手指的患者,利用第二跖背动脉或第二趾底总动脉在第三足趾发出的分支血管,设计局部转移皮瓣,将其嵌入第二趾中节的腓侧,以增加第二趾的周径;利用趾背动脉之间、趾背与趾足底动脉之间、趾足底动脉之间存在的吻合,设计趾腹皮瓣,将其嵌入第二趾跖侧,消除再造手指狭细的形态.将第二趾整形后,再移植于手部,再造拇、手指.结果 26例38指,76块局部转移皮瓣全部存活,对供区第三趾血运无影响,再造手指外形非常满意.结论 以第二、三趾局部转移皮瓣对第二趾整形,再进行拇、手指再造,此法是改善再造手指外形的良好方法.