一蒂双足趾组织组合移植修复复合性手创伤

目的探讨一种简便、有效的治疗复合性手创伤的方法。方法1995年始，对12例复合手外伤均采用一蒂双足趾组织移植修复；其中用改良甲瓣加第二足趾移植再造手4例，指、第二足趾双趾腹皮瓣移植修复6例，足背皮瓣加趾趾腹皮瓣移植修复2例。急诊一期修复5例，延迟修复4例，二期修复3例。术后均经系统的康复治疗。结果12例的皮瓣及再造指全部成活。2例(足趾、皮瓣各1例)在术后发生动脉危象，手术探查、处理后成活。术后1年随访，再造指外观良好，TAM平均为140°，指腹二点分辨觉平均为8mm。再造指对掌、对指正常3例，轻度受限1例。移植皮瓣无明显臃肿，二点分辨觉平均为12mm。结论一蒂双足趾组织移植只吻合一套血管系统，供养两块组织，手术简便、安全、实用。保证移植组织的双套供血回流系统，及保持虎口、指蹼间的正常跨度是手术成功的关键。

Repair of compound traumatic hand by combined transplantation of one pedicled double

Objective To investigate a simple and effective procedure for compound traumatic hand. Methods Since 1995, 12 patients were repaired by one pedicled double toes transplantation, of which modified halluce wrap around flap and second toe was done in 4 cases ; double palmar flap from halluce and second toe in 6 cases ; foot dorsal flap and halluce palmar flap in 2 cases. Of total cases , primary repair had 5 patients ; delayed repair 4 patients and secondary repair 3 patients. Comprehensive rehabilitation was done postoperatively. Results All transplants survived in 12 cases successfully. Arterial crisis occurred postoperatively in two cases. The flap survived after surgical exploration and corresponding treatment. During one year period follow up , appearance of reconstructed fingers was good, and total active movement of reconstructed fingers averaged 140 degree. Two point discrimination at the palmar side averaged 8 mm .The reconstruction of hands gained normal abduction in 3 cases and mild dysfunction in 1 cases. There was no obvious enlargement in transplanted flap with mean two point discrimination 12 mm. Conclusions One pedicled double toes transplantation only have one set of vessel anastomosesed, which supplied two sets of tissues. The strategy is simple, safe and practical. Ensurance of double supply and reflow system and maintaining normal space of first web are the key points of the operation.