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。

Modified wrap-around flap for thumb reconstruction

Objective To introduce the surgical techniques and results of modified wrap-around flap for thumb reconstruction. Methods From November 2001 to October 2003, eleven cases of thumb defect were treated with modified wrap-around flap to reconstruct the thumb. There were 6 cases of IIA defect and 5 cases of IIB defect. The wrap-around flaps were harvested from the big toe from the same side of the injured thumb. The neurovascular pedicles of the flap were similar to that of the traditional procedure. Instead of leaving a stripe of skin pedal on the tibial side of the big toe, the plantar skin was remained when harvesting the transplant to preserve the weight bearing area. The tibial plantar digital artery and nerve of the big toe were preserved in the skin. Results The patients were followed 6 months to 2 years postoperatively. The transferred flaps survived in all cases. Both the cosmesis and function of the reconstructed thumbs were consistent with those reported for the use of the traditional wrap-around flap. In 10 cases the total or most length of the donor toes were preserved. In 1 case the remaining skin flap on the donor big toe was partial lost and a secondary procedure was required. All patients could walk and run normally without pain and postoperative skin erosion or ulceration. The postoperative gait analysis was normal, static footprint analysis and dynamic mechanical analysis were consistent with those of the opposite site. Conclusion This modified wrap-around flap for thumb reconstruction was not more technically demanding than the traditional procedure. Morbidity of the donor site, however, was much minor than that of the conventional one.