游离第二足趾移植一期修复拇指和手指缺损

目的观察急诊应用游离第二足趾（或）带足背皮瓣移植。一期修复拇指和手指缺授的临床疗效。方法对本组67例共83指不同程度拇指、示指和中指的缺损，急诊游离第二足趾（或）带足背皮瓣移植，通过不同的动脉和静脉吻合方式，重建血液循环，改进骨的内固定方法和肌腱吻夸方法，再造拇指和手指。结果所有再造指均全部成活，无一例患者出现肌腱断裂和骨不连。走部分病例获得随访6个月～5年，再造指外形皿功能良好，末梢感觉二点分辩率为5～12mm。供区所植的皮片均成活，感觉和外观令人满意。供足术后2～3个月可恢复正常的行走、负重功能。结论急诊游离第二足趾移植再造拇、手指具成活率高的优点，是值得广泛开展的修复手指缺顿的有效方法。

PRIMARY EMERGENCY REPAIR OF THUMB AND FINGER DEFECTS WITH THE FREE SECOND TOE TRANSPLANTATION

Objective To report the clinical effect of primary repair on thumb and finger defects with the free second toe transplantation. Methods 67 cases (83 fingers) with different degree defects of thumb, index and middle fingers were emergent repaired by the free second toe with foot dorsal skin flap. Blood circulation of the transplanted fingers was reconstructed by different arterial and venous anastomosis ways, the methods of by bony internal fixation and tedeon anastomosis were modified in the reconstruction of thumb and finger. Results All reconstruction thumbs and fingers were survived completely and no tendon broken and bone nonunion happened. The majority of total cases were followed-up for 6 months to 5 years and the results had shown that the reconstructed thumbs and fingers were good in outward appearance, sensory recovery and motor function. Two point discrimination was 5-12 mm. The transplanted skin flaps in donor site of foot were survived evenly, their sensation and external appearance were satisfied. The functions of sensation, walking and weight bearing of donor foot recovered in 2-3 months after operation. Conclusion Primary repair of thumb and finger defects with the free second toe transplantation has advantage of very high successful rate and be proved to have powerfully clinical value.