保留脚趾的拇甲瓣再造拇指甲床缺损

【摘要】目的探讨用小块拇甲瓣游离移植修饰性修复拇指甲床缺损同时保留脚趾的临床效果。方法根据拇指末节甲床及皮肤软组织缺损情况，遵循缺多少补多少的原则，采用同侧或对侧第一脚趾小块拇甲瓣游离移植修饰性修复拇指甲床缺损，吻合趾一指固有动脉、神经。第一脚趾残留甲床、骨骼及皮肤软组织体于甲根部咬断骨骼，组织体旋转90。转移覆盖拇趾创面。结果我院从2008年7月～2011年12月应用小块拇甲瓣游离移植修饰性修复拇指甲床缺损13例13指，术后13例拇甲瓣均成活。术后经过9个月～2年随访，皮瓣质地弹性及拇指外形良好，感觉较好，在持物时无疼痛、感觉过敏，持物方便舒适，两点辨别觉5～10mm。按中华医学会手外科分会再植与再造功能评定试用标准评定，优良率95％；供区行走无影响，供区第一趾保留部分趾甲生长，外观良好。结论小块拇甲瓣游离移植修饰性修复拇指甲床缺损．是修复拇指甲床缺损的理想方法。

Keep toes and reconstruct the thumb nail bed defect

Objective To investigate the use of a small thumb nail flap free grafting modification of repair of thumb nail bed defects while retaining the toe of the clinical effect.Methods According to the distal thumb nail bed and the skin and soft tissue defect,follow the missing number fill how many principles,using the ipsilateral or contralateral to the first toe piece of hallux nail flap free transplantation of modified repair of thumb nail bed defects,toe and finger artery anastomoses,nerve.The first toe residual nail bed,skeletal and soft tissue body on the nail root tissue,skeletal,rotate 90 degrees covered toe transfer wound.Results In our hospital from 2008 July to 2011 December using small hallux nail flap free grafting modification of repair of thumb nail bed defect in 13 cases 13,13 patients with postoperative hallux nail flaps survived.Results After September to 2 years of follow-up,the flap is elastic and the thumb in good shape,feel better,in holding without pain,hyperalgesia,holding comfortable,two-point discrimination of 5-10 mm.According to Chinese Medical Association of hand surgery branch of replantation and reconstruction of function evaluation test standard,the excellent and good rate was 95%;for the district to walk without effect,for the first toe retaining part toenail growth,good appearance.Conclusion Small hallux nail flap free grafting modification of repair of thumb nail bed defect,repair of thumb nail bed defect is a ideal method.