第二足趾再造手指外形的重塑整形

目的 比较三种不同方法重塑第二足趾再造手指外形的疗效.方法 2003年4月-2008年1月,对31例第二足趾再造手指,分别采用三种不同方法重塑再造指外形.其中7例一期采用再造指局部三角皮瓣转移;9例一期采用邻趾侧方皮瓣转移嵌入再造指指腹颈部;15例二期采用再造指指腹侧方梭形切除术.结果 术后31例再造手指全部存活.16块转移皮瓣,除1块邻趾侧方皮瓣部分坏死,经二期换药后愈合外,其余转移皮瓣均存活.经8～15个月的随访,一期整形的再造指外形明显改善;二期整形的再造指指腹膨大得到明显改善,但指腹颈部的狭窄没有改善.所有再造指感觉均恢复,两点分辨觉为6～11mm. 结论一期行再造指局部三角皮瓣转移重塑外形,同时改善了再造指指腹膨大和掌侧颈部狭窄的外形缺陷,是改善再造指外形的较好方法.

Plasty of the fingers reconstructed by second-toe transfer

Objective To compare the results of modifying the appearance of fingers reconstructed by second-toe transfer using three different methods. Methods From April 2003 to January 2008, three different approaches were employed to build the shape of the fingers reconstructed by second-toe transfer in a total of 31 eases. In 7 cases a local triangle-shaped flap from the reconstructed finger was transposed in the same stage of second-toe transfer, while in 9 eases-a Lateral/island toe-flap from the adjacent toe was transferred to and inset in the pulp of the reconstructed finger in the same stage of second-toe tinnier. Another 15 eases underwent longitudinal fusiform excision from the pulp of the reconstructed finger at a second stage. Results All 31 reconstructed fingers survived. Complete flap survival was achieved in the 16 transposed flaps with the exception of one finger that presented partial necrosis of the inset lateral island toe-flap, which healed secondarily after dressing changes. After 8 to 15 months of follow up, obvious improvement in appearance was noticed in the fingers reconstructed with one-stage plasty using flap transfer. Although finger-pulp bulkiness was noticeably reduced in the fingers reconstructed with secondary plasty, narrowness at the neck of finger-pulp was not improved. Sensory functions were restored in all reconstructed fingers, with two-point discrimination of 6 to 11 mm. Conclusion One-stage plasty of the reconstructed finger using local triangle-shaped flap transfer can correct bulkiness of the finger-pulp and narrowness at the neck simultaneously. It is an optimal approach to achieve satisfactory appearance in second-toe transfer for finger reconstruction.