皮肤软组织扩张术再造拇指

目的 寻求一种低损伤,重造拇指,再建手功能的新术式。方法 采用手掌部皮肤、软组织扩张,Ⅱ期行扩张皮瓣加自体髂骨块游离移植完成再造拇指。结果 再造拇指４例,全部成活,外形良好,感觉功能优良,耐磨擦。结论 此方法利用皮肤软组织扩张后皮瓣再造拇指,操作简便、安全、可靠,避免大创伤再造术给患者带来的恐惧心理,为部分拇指缺损患者提供一个新方法,适用于拇指Ⅴ－Ⅵ度缺损伤。     

不同构制手指转位再造不同程度的拇指缺损

[目的]探讨不同构制的手指转位再造不同程度拇指缺损的方法和临床效果。[方法]1997年4月~2013年11月对21例Ⅲ~Ⅴ度不同类型拇指缺损采用示指转位再造拇指8例9指,示指残端转位2例,环指中远节转位再造拇指Ⅲ~Ⅳ度缺损5例,示指带掌指关节、部分掌骨转位再造拇指,以第2掌骨基底作为支掌点形成与远端第2掌骨重叠为夹角,产生新形成虎口并皮瓣移植修复新形成的虎口皮肤缺损,重建拇指Ⅵ度缺损6例。术后行康复训练治疗。[结果]21例22指再造指加6块皮瓣移植全部成功,拇指血供正常。术后随访6个月~3年。拇指掌指关节屈曲后可与所有手指对指,虎口开大5~9 cm,接近于健侧拇指;Ⅵ度拇指缺损再造后其原示指的PIP关节等同于正常拇指的MP关节功能、原示指的MP关节僵直等同于第一掌骨。所有拇指感觉经过感觉再训练恢复正常,两点分辨觉同健侧。可以完成日常生活和参加原工作。[结论]通过显微外科的方法将不同程度的拇指缺损采用不同手指转位再造拇指,恢复拇指的外形和功能,是一种可行的途径。     

第二趾与足内、外侧皮瓣复合组织移植再造拇指

目的介绍应用第二趾与足内、外侧皮瓣复合组织移植一期再造拇指的方法。方法对6例拇指Ⅳ°、Ⅴ°缺损及合并虎口及桡侧软组织缺损的患者,设计以胫前动、静脉为蒂的第二趾移植再造拇指与带足内、外侧皮瓣组合移植修复虎口及掌部桡侧皮肤缺损。结果6例再造拇指及双叶皮瓣全部成活。1例术后6h发生血管危象,经手术探查、处理后成活。术后随访4~9个月,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4例,良2例。移植皮瓣无臃肿,两点分辨觉为11~15mm。供区行走无影响。结论第二趾与足内、外侧皮瓣复合组织移植是修复拇指Ⅳ°、Ⅴ°缺损及合并虎口及桡侧软组织缺损的理想治疗方法。     

带足外侧、足背皮瓣的第二趾移植再造Ⅴ、Ⅵ区拇指缺损

拇指缺损合并手其它部位的皮肤缺损。或是拇指Ⅴ、Ⅵ区的缺损常导致手掌侧及虎口区皮肤同时缺损，需用带足外侧、足背皮瓣的第二足趾游离移植的方法再造拇指。我们对7例患者采用上述方法处理，术后功能比较满意。     

应用前臂逆行岛状皮瓣及带足背皮瓣第2足趾游离移植再造修复拇指Ⅵ度缺损

目的：分析拇指Ⅵ度缺损应用前臂逆行岛状皮瓣及带足背皮瓣第2足趾游离移植再造修复术后的临床效果。方法2010-2013年,采用该法修复拇指Ⅵ度缺损伴或不伴第2掌骨掌背侧皮肤瘢痕、缺损5例,其中前臂岛状皮瓣应用尺动脉腕上支皮瓣3例,应用骨间背侧动脉皮瓣2例。术后常规制动,抗炎、解痉、防凝及对症治疗,指导康复锻炼。结果再造拇指及皮瓣均全部成活,经6～36个月随访,移植再造指恢复触、痛、温觉,两点辨别觉6～10 mm;皮瓣不臃肿,质地、色泽与周围皮肤接近,面积有轻微萎缩,有不同程度感觉恢复。虎口无挛缩,所有病例均恢复良好的对指、对掌功能。结论拇指Ⅵ度缺损应用前臂逆行岛状皮瓣及带足背皮瓣第2足趾游离移植再造修复较之常规应用远隔游离皮瓣再造修复方法简单,操作方便,风险小,探查率小,成活率高。     

游离第二趾与筋膜皮瓣组合再造Ⅵ度缺损拇指

目的介绍携带足背皮瓣游离第二足趾与逆行前臂筋膜皮瓣转移再造Ⅵ度缺损拇指的疗效。方法为Ⅵ度缺损拇指行再造32例，其中18例采用尺动脉腕上支皮瓣，14例采用骨间背皮瓣，分别与游离第二趾移植相结合进行再造。结果所有再造指均存活，术后随访6个月～3年（平均22个月），按中华医学会拇手指再造功能评定标准，所有再造指功能优良率100％。结论第二足趾移植与前臂筋膜皮瓣转移相结合为Ⅵ度拇指缺损再造提供一种有效的方法。     

拇指Ⅵ度缺损的拇指再造

目的　探讨示指带部分掌骨重建拇指Ⅵ缺损的显微外科治疗方法。　方法　采用示指带掌指关节、部分掌骨移植再造拇指 ,以第二掌骨基底作为支撑点 ,形成与远端第二掌骨重叠并为夹角 3 0° ,重建虎口和吻合血管的股前外侧皮瓣修复虎口皮肤缺损 6例。术后行康复训练治疗。　结果　 6例全部成功 ,术后随访 3个月以上 ,再造拇指感觉恢复良好 ,并获得满意的外形及功能。　结论　示指带部分掌骨转位加皮瓣移植修复虎口术是拇指Ⅵ度缺损恢复拇指功能的理想方案。     

拇指近节指背筋膜蒂岛状皮瓣急诊修复拇指末节软组织缺损

目的 探讨拇指近节指背筋膜蒂岛状皮瓣急诊修复拇指末节皮肤、软组织缺损的临床疗效。 方法 2007年5月至201 1年4月,对拇指末节皮肤软组织缺损采用拇指近节指背筋膜蒂岛状皮瓣急诊修复50例,拇指末节偏桡侧缺损,以拇指指间关节桡侧与掌指关节尺侧连线为轴线。拇指末节偏尺侧缺损,以拇指指间关节尺侧与掌指关节桡侧连线为轴线。在轴线背侧设计皮瓣,切取皮瓣面积3.0 cm×2.5 cm～2.0 cm×1.5 cm。 结果 42例皮瓣均成活,其中5例术中发现蒂部卡压,3例术后蒂部卡压,经处理后均成活,皮瓣血液循环良好。术后随访1个月～2年,皮瓣弹性、质地良好,无色素沉着。皮瓣感觉恢复S3 12例,S2 8例。 结论 应用拇指近节指背筋膜蒂岛状皮瓣修复拇指末节软组织缺损,手术成活率高,临床效果良好。     

前臂后皮神经营养血管远端蒂皮瓣在拇指再造中的应用

目的探讨前臂后皮神经营养血管远端蒂皮瓣在拇指严重缺失再造中的临床应用疗效。方法采用前臂后皮神经营养血管远端蒂皮瓣对9例拇指严重缺失患者的（其中Ⅴ度6例,Ⅵ度3例）手部皮肤缺损进行修复,重建虎口,同时完成拇指再造。结果9例再造拇指及皮瓣全部成活,均获3～18个月随访,再造拇指功能及皮瓣外形良好,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2例,良4例,可2例,差1例。结论前臂后皮神经营养血管远端蒂皮瓣质地良好,切取安全、简便,不需吻合血管,成活率高,利用它修复严重拇指缺失再造中的手部皮肤缺损并重建虎口．可较好地恢复拇指的外形与功能。     

带足背皮瓣的足部寄养指回植再造拇指

目的 探讨足部寄养指回植再造拇指时利用携带的足背皮瓣修复手部皮肤缺损的可行性.方法 2005年2月至2011年12月,将10例在足背寄养1.5～4.0个月的手指回植再造拇指.其中拇指Ⅲ度缺损1例,Ⅳ度缺损3例,Ⅴ度缺损6例.在切取足背寄养指时携带部分足背皮瓣同时修复手部皮肤缺损,其中6例手指双侧携带足背皮瓣呈瓦合状、4例一侧携带足背皮瓣呈单片状,每侧皮瓣面积为2cm×1 cm～3cm×3cm,移回手部后将与手指相连的足背动脉与桡动脉吻合,大隐静脉与头静脉吻合.结果 10例再造拇指及所携带的足背皮瓣全部存活,切口Ⅰ期愈合,4例术后早期皮瓣略肿胀,色泽略深,弹性稍差,半年后均恢复正常.结论 利用寄养指所带的足背皮瓣修复寄养指回植再造拇指时的皮肤缺损是一种可行的手术方法.     

Digital reconstruction and donor site resurfacing: a two-flap technique

Use of a great toe pulp flap is one of the methods to repair partial soft-tissue defect of the thumb or other digits. However, the conventional application of free skin grafts to close the donor site may bring donor-site morbidity. The authors present a two-flap technique that a reverse first dorsal metatarsal artery (FDMA) flap resurfaces the defect of the free great toe pulp flap. Six patients with soft-tissue defects of the thumbs or fingers were treated with this technique. Both the pulp and reverse flaps survived uneventfully after reconstruction of the thumbs and fingers. The reverse flap to resurface the donor site on the great toe was sensate and durable. Satisfactory appearance and function were gained in all patients. Results revealed that this technique can be accepted as an alternative method when treating soft tissue defect of the thumb or finger.     

足趾及复合足趾移植急诊再造和修复拇手指缺损

目的 探讨一期应用足趾及足趾复合组织移植拇、手指再造与修复的方法与疗效.方法 采用吻合血管的趾甲皮瓣、第二足趾及带足背皮瓣趾甲皮瓣或第二足趾移植,带小腿远端合并前踝及足背皮瓣的第二足趾移植,部分胫侧趾甲皮瓣合并第二足趾移植再造与修复拇指缺损、手指缺损及合并大鱼际、虎口、手掌部或前臂桡侧软组织等部位的复合性损伤的拇、手指缺损共282例,314指. 结果 术后308指再造成活,成活率为98%,术后经6个月～6年的随诊和信访,其再造修复后的拇、手指恢复了捏、握及对掌的功能.按中华医学会手外科分会上肢部分功能评定;优214指,良63指,可26指,差5指,优良率达88%. 结论 选择不同类型的足趾及复合足趾移植急诊再造和修复拇、手指缺损,可获得较好的临床疗效.     

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.     

(踇)甲瓣联合第二趾胫侧皮瓣修复拇指及虎口区皮肤缺损

目的 报道13例(踇)趾甲瓣联合第二趾胫侧皮瓣修复拇指及虎口皮肤缺损的临床效果.方法 2003～2007年间应用躅趾甲瓣联合第二趾胫侧皮瓣修复13例拇指及虎口皮肤缺损,其中2例为全手皮肤脱套伤.根据动脉的Gilbert分型采取不同的切取方式,2个组织瓣的神经应分别与受区相应神经吻合.结果 术后再造指及皮瓣全部成活,受区创面全部一期愈合.术后9例获得随访,平均随访时间7个月.再造指及皮瓣色泽与正常拇指相近.1年以上随访病例感觉恢复好,痛触温觉敏感,两点辨别觉为7～17 mm.拇指外展60°～85°,平均75°.拇指功能好,患者能恢复正常工作生活.结论 将拇指和虎口作为一个整体进行修复.应用(踇)趾甲瓣联合第二趾胫侧皮瓣修复拇指合并虎口区皮肤缺损是一种有效的修复方法,有利于手功能的恢复.     

背甲皮瓣移植联合带指神经血管蒂岛状皮瓣移位再造拇指

目的探索拇指再造的新术式。方法采用吻合血管的背甲皮瓣移植联合带指神经血管蒂的岛状皮瓣移位,急诊延迟再造拇指。根据拇指残端情况,可选用中指尺侧或环指桡侧的岛状皮瓣。结果再造拇指３例全部成活,外形与功能恢复均良好。结论为急诊延迟再造拇指提供一种新方法,适用于拇指皮肤脱套伤及Ⅱ、Ⅲ度截指。     

双微型皮瓣移植在拇指近节离断伴皮肤缺损断指再植中的应用

目的报道应用双微型皮瓣移植在拇指近节水平离断伴皮肤软组织缺损断指再植中的临床疗效。方法2000年1月-2003年8月,对14例拇指近节水平的断指,根据断指近端软组织缺损情况,应用动、静脉双微型皮瓣移植进行断指再植修复术。结果再植拇指及皮瓣全部存活,术后随访10~28个月,皮瓣质地柔软,外形良好,按上肢部分功能评定标准评定[1]:优11例,良3例,拇指两点分辨觉达4.5~6.5mm。结论双微型皮瓣在修复拇指近节水平离断伴严重软组织缺损中有很好的应用价值。     

"FACE TO FACE": A NEW METHOD FOR THE TREATMENT OF POLYDACTYLY OF THE THUMB THAT MAXIMISES THE USE OF AVAILABLE SOFT TISSUE

Some patients with distal phalangeal polydactyly of the thumb have severe hypoplastic pulps that are difficult to make sufficiently large with either the fillet flap method or a symmetrical combination, the Bilhaut-Cloquet method. We have devised a new method to reconstruct the largest possible pulp by resecting only a minimum amount of soft dorsal skin tissue with one nail and not resecting any of the palmar skin of the thumbs. By contrast, other procedures require some resectioning of soft tissue of both the dorsal and the palmar skin. We have treated 13 cases with distal phalangeal polydactyly of the thumb since 1988 in this way. All the thumbs were successfully reconstructed with a sufficiently large pulp. The only problem was slight instability of the skin of the pulp after the operation, but this condition gradually improved during a five-year follow up. We think that this method facilitates the reconstruction of a sufficiently large pulp when both bifid pulps are hypoplastic.     

"Face to face": a new method for the treatment of polydactyly of the thumb that maximises the use of available soft tissue.

Some patients with distal phalangeal polydactyly of the thumb have severe hypoplastic pulps that are difficult to make sufficiently large with either the fillet flap method or a symmetrical combination, the Bilhaut-Cloquet method. We have devised a new method to reconstruct the largest possible pulp by resecting only a minimum amount of soft dorsal skin tissue with one nail and not resecting any of the palmar skin of the thumbs. By contrast, other procedures require some resectioning of soft tissue of both the dorsal and the palmar skin. We have treated 13 cases with distal phalangeal polydactyly of the thumb since 1988 in this way. All the thumbs were successfully reconstructed with a sufficiently large pulp. The only problem was slight instability of the skin of the pulp after the operation, but this condition gradually improved during a five-year follow up. We think that this method facilitates the reconstruction of a sufficiently large pulp when both bifid pulps are hypoplastic.     

Thumb reconstruction with combination of the wrap-around flap prefabricated by medialis pedis perforator flap with nail bed and phalanx banked from the amputated thumb: A case report

Thumb reconstruction has been a very challenging issue for hand surgeons. In this report, we present a case of thumb reconstruction with combination of the wrap-around flap prefabricated by the medialis pedis perforator flap with phalanx and nail bed banked from the amputated thumb. A 22-year-old man suffered from the left thumb amputation as well as large soft tissue defect of hand and comminuted fracture in wrist due to a crush accident. The distal phalanx and nail bed of left thumb were exposed and no suitable vessels for microsurgical anastomosis could be found, resulting in the great difficulty of replantation. After debridement, nail bed of the amputated thumb was dissected and banked on the medial side of foot, while the distal phalanx was buried in the abdominal subcutaneous tissue. The fracture was fixed with an external fixation and the soft tissue defect was covered with a free anterolateral flap. Wound and bone healing was achieved 6 months after the initial treatment. Thumb was reconstructed with combination of the banked phalanx and a wrap-around flap prefabricated by the medialis pedis perforator flap and the banked nail bed. The postoperative course was uneventful with complications from both reconstruction and donor sites. The nail of the reconstructed thumb grew normally. Thumb oppositional function was rebuilt. The patient was satisfied with the aesthetic and functional outcome at 5-year postoperative follow-up. We propose that tissue banked from the nonreplantable amputated thumb could be used for secondary reconstruction with the technique of flap prefabrication.     

组织瓣联合移植一期重建拇指和虎口

目的介绍组织瓣联合移植重建拇指和虎口的疗效。方法临床应用２或３个组织瓣联合移植,一期重建拇指和虎口复合组织缺损９例。结果术后平均随访３年,再造拇指感觉均已恢复,两点辨别觉４～７ｍｍ。拇指均恢复了持物和对指、对掌功能,效果满意。７例同时再造虎口者,虎口开大幅度正常或接近正常,另２例达健侧的６０％～７０％。结论应用吻合血管的组织瓣联合移植,一期重建拇指和虎口是个疗程短、疗效好的方法。