改良第1趾蹼皮瓣游离移植修复手功能区皮肤缺损

目的 探讨改良第1趾蹼皮瓣游离移植修复手功能区皮肤缺损的方法和临床疗效.方法 2008年2月-2013年8月,收治手部重要功能区皮肤缺损病例31例,男18例,女13例,年龄17～58岁,平均41.5岁.其中拇指15例,虎口10例,食指6例,皮肤缺损面积：2.0 cm×3.0 cm～ 3.9 cm×7.2 cm.行改良第1趾蹼皮瓣游离移植修复,游离皮瓣切取面积2.3 cm×3.4 cm ～ 4.2 cm×9.0 cm,皮瓣供区游离全厚皮植皮打包或局部带蒂皮瓣转位关闭.结果 31例游离皮瓣全部成活,术后无皮瓣瘀血、血管危象等并发症,供区植皮、局部皮瓣修复及取皮区均一期愈合.术后随访7～32个月,手部创面修复后外形美观,与受区融为一体,无臃肿,皮瓣感觉功能恢复至S3 6例,S3＋ 13例,S4 12例,手部功能恢复良好,皮瓣供区功能无影响,手指主动活动度（TAM）优24例,良6例,劣1例,优良率96.7％.结论 改良第1趾蹼皮瓣质地优良,与手部皮肤结构相似,游离移植安全、可靠,修复质量高、功能恢复好,最大限度保护了患手的外观,临床治疗效果好,是修复手功能区皮肤缺损的理想选择.

Modified first toe web flap graft to repair the skin defects located at hand functional areas

Objective To investigate the clinical efficacy of modified method of the first toe web flap graft to repair functional areas of hand skin defects.Methods From February 2008 to August 2013,31 patients were included due to hand skin defect of important functional areas.（M：18 cases; F：13 cases）.Mean age：41.5 years （17-58）.15 cases of skin defect located in thumb,10 cases in web between first and second finger,6 cases in index finger.The skin defect areas ranged from 2.0 cm×3.0 cm to 3.9 cm×7.2 cm.Modified method of first toe web flap graft was taken to repair the skin defect.Flap size ranged from 2.3 cm×3.4 cm to 4.2 cm×9.0 cm.Free flap donor site packed full thickness skin graft or local closed pedicle flap transposition.Results All the 31 cases of free flaps survived,no postoperative flap congestion or other complications.Donor skin graft,local flap and donor site healed with followed up from 7 to 32 months.The hands are in good appearance after wound healing,no bloated feeling flap.The hand function recovered to S3 for 6 cases,S3＋ for 13 cases,S4 for 12 cases.The hand function was in good recovery without affect of flap donor function.According to total active motion （TAM） standard,the finger function was assessed as excellent in 24 cases,good in 6 case,and poor in 1 case,and the excellent and good rate was 96.7％.Conclusion The modified first toe web flap is similar to the hand skin.The free flap is reliable,high-quality to repair the hand skin defect.The modified method could achieve good hand functional recovery,maximum protection of the affected hand outlook,which is an optimal choice to repair hand functional areas of skin defect.