手指再造手术中砪甲瓣供区的修复

目的 探讨手指再造手术中砪甲瓣供区的修复方法。 方法 从1998年12月至2010年12月,共修复砪甲瓣供区511例,分别应用足背皮瓣32例、第1跖背皮瓣24例、第2跖背皮瓣21例、踝前皮瓣14例、跗内侧皮瓣17例、跗外侧皮瓣79例、跖底皮瓣106例、第2趾皮瓣79例、小腿中下段皮瓣15例以及游离皮瓣124例。 结果 皮瓣成活良好,术后经过6个月～11年随访,见皮瓣质地良好,外形满意,砪趾活动及负重行走、跑跳等皆不受影响。 结论 砪甲瓣供区的修复方法较多,各有优缺点,以跖底皮瓣及游离腹股沟皮瓣为优。     

手指Ⅳ～Ⅵ度缺损的全形再造

目的 介绍手指Ⅳ～Ⅵ度缺损的全形再造方法。 方法 自1998年12月至2010年12月,对手指Ⅳ度缺损63例85指,Ⅴ度缺损31例49指,Ⅵ度缺损17例23指进行了手指全形再造。保留4个足趾的,（足母）甲瓣供区用2趾甲皮瓣修复;保留5个足趾的,（足母）甲瓣供区用皮瓣移位或移植来修复,第2足趾关节供区取髂骨充填。手指Ⅳ度缺损和部分Ⅴ度缺损,采用（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣,串1条髂骨再串第2趾近侧趾间关节的方法再造。部分近节指骨缺失长度较长的Ⅴ度缺损手指,采用（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣,串l条髂骨,再串第2趾近侧趾间关节,最后还要在近节指骨残端与移植的第2趾近侧趾间关节间再串l条髂骨的方法再造。Ⅵ度缺损的手指,采用以下顺序串连：（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣,串l条髂骨,串第2趾近侧趾间关节重建手指近指间关节,串l条髂骨重建近节指骨,串第2跖趾关节重建掌指关节的方法再造。 结果 再造手指157指全部成活。平均随访7个月～11年,其中75指行二期整形手术。再造手指外形美观,再造指指腹两点辨别觉为5～12mm。67指行术后肌腱松解手术,再造指间关节活动度：伸-10°～10°,屈55°～ 100°,平均81°。结论 手指Ⅳ度至Ⅵ度缺损全形再造,再造的手指兼具美观外形与良好运动功能,缺点是手术较复杂。     

手指Ⅰ～Ⅲ度缺损的全形再造

目的 介绍手指Ⅰ至Ⅲ度缺损全形再造的方法。 方法 从1998年12月至2010年12月,对手指Ⅰ度和Ⅱ度缺损,根据受区需要设计切取（足母）趾腓侧部分趾甲、趾甲下趾骨的腓背侧部分以及皮肤,形成趾甲、骨、皮肤复合组织瓣。皮瓣卷成圆筒状包裹趾骨形成新的手指远段,像断指再植一样,将再造的手指远段移植到手指残端形成新的手指。对于手指Ⅲ度缺损,皮肤仍根据残指需要的大小在（足母）趾上设计,但趾骨因只能在（足母）长伸肌腱止点以远切取,且只切取腓背侧部分,长度有限,有些病例不能达到原缺损的长度时,则取适当大小形状的髂骨与取下的趾骨串在一起,移植到手指残端再造出新的手指。部分手指Ⅲ度缺损病例,同时切取第2足趾趾间关节移植再造手指远侧指间关节。第2足趾骨缺损用髂骨充填以保持第2趾的外形。（足母）趾创面采用局部皮瓣移位修复或游离皮瓣移植修复。 结果 Ⅰ度缺损118例126指,Ⅱ度缺损187例201指,Ⅲ度缺损90例111指全部成活,外形接近正常手指。其中150指进行了1～5年的随访,手指总活动度全部达到180°以上。趾间关节移植再造远指间关节的病例术后再造手指远指间关节活动度为15°～40°。供区（足母）趾术后长度与周径接近正常,虽然趾甲大部分缺失,但供足行走功能全部正常。 结论 （足母）趾腓背侧复合组织瓣移植或（足母）趾腓背侧复合组织瓣加髂骨串联移植再造手指Ⅰ至Ⅲ度缺损,再造手指功能外形俱佳,供区皮瓣修复后（足母）趾形状与功能所受影响小。     

双(母)趾甲骨皮瓣拼合法再造手指

目的 探讨双侧(母)趾甲骨皮瓣拼合移植再造手指的方法及效果.方法 在双侧(母)趾各 切取半侧(母)趾甲骨皮瓣,再将两个半侧(母)趾甲骨皮瓣拼合成手指外形后移植于残指残端,再造缺损的部分手指.(母)趾甲骨皮瓣供区采用跖底皮瓣或足部其他皮瓣移位修复.2003年6月至2009年6月,应用该方法再造手指20例20指,缺损程度为...     

双(母)趾甲骨皮瓣拼合法再造手指

Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers (20 cases) which had defect degrees range from I to Ⅲ underwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery: all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers' total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites.     

双侧[足母]趾甲骨皮瓣拼合移植术再造手指15例报告

用一个[足母]趾甲皮瓣或[足母]趾甲骨皮瓣再造手指,趾甲会全部或大部缺失,术后[足母]趾外形明显改变。2003年3月-2008年3月,我们采用双侧[足母]趾甲骨皮瓣拼合移植再造手指15例（15指）,取得了满意效果。现报告如下。     

指背多级推进皮瓣的解剖学研究

目的　通过皮肤的延展性、皮下浅筋膜的滑动性、指固有动脉背侧支的角位移及指固有动脉的弹性等多级推进的方式来增大指背带蒂皮瓣的推进距离修复指背创面。 方法　新鲜成人手标本11侧34指,在手指的中节与近节的背侧分别设计皮瓣,皮瓣的内容包括指背皮肤、皮下浅筋膜、手指一侧指固有动脉以及指固有动脉发出的背侧支。将皮瓣向指背远端推进,皮肤的延展性、皮下浅筋膜的滑动性、指固有动脉背侧支的角位移与指固有动脉的弹性,这4个因素都各自对指背皮瓣推进起到一定作用,通过这4种作用的多级叠加作用增大皮瓣推进距离。 结果　在新鲜标本上模拟的指背多级推进皮瓣的最大推进距离中节指背皮瓣为2.4 cm,近节指背皮瓣4.5 cm。 结论　多级推进式指背皮瓣推进距离明显增加,最大推进距离为4.5 cm,平均距离为2.5 cm,其手术操作安全、简便,是修复指背中小型创面的理想皮瓣之一。     

双(母)趾甲骨皮瓣拼合法再造手指

Objective To report our usage of a combined flap which is constituted of bilateral hallux nails, skins, bones to reconstruct a finger, and to introduce the method and outcome of this way. Methods Combine two halves of halluxes harvested from both feet to reform a fabricated finger and then transplant it to the finger stump to reconstruct the defect part of the finger. Plantar flaps or some other flaps near the donor sites were transposed to cover them. From June 2003 to June 2009, a total of 20 fingers (20 cases) which had defect degrees range from I to Ⅲ underwent reconstruction surgeries in this way. Results All the 20 fingers transplanted survived completely. Follow-ups 1 to 5 years after each surgery: all the fabricated fingers had very realistic configurations. The MP joints of the reconstructed thrumbs got to the normal range of motion, and the other reconstructed fingers' total ROM were 203 degree on average. All the reconstructed fingers had the sensation function above S3,and their two-point discriminations ranged from 6mm to 10mm. Both halluxes of each case were conserved major parts of nails and had nice, symmetric appearances. All the flaps for the donor halluxes survived completely, and none of the cases showed pains, ulcers or abrasions of their feet. All the cases showed normal gaits during follow-ups. Conclusion The combined flap by bilateral hallux nails, skins, bones is an ideal alteration for finger defect reconstruction for the important advantages of realistic configuration as well as minor destructions to donor sites.