足部皮瓣移植修复拇、手指皮肤缺损

目的 探讨应用5种足部皮瓣移植修复拇、手指皮肤缺损的疗效。方法 1987年5月-2003年6月，对93例拇、手指皮肤缺损的患者，采用5种不同类型的足部皮瓣进行移植修复。其中采用趾腹皮瓣移植修复指腹缺损27例；趾甲瓣移植修复指甲与指背皮肤缺损8例；[足母]甲瓣或第二趾趾甲皮瓣移植修复拇、手指皮肤脱套伤48例；[足母]趾腓侧半月形皮瓣移植修复拇、手指近节与（或）中节皮肤环形缺损6例；足背三叶或二叶皮瓣移植修复2～3个手指部分皮肤缺损4例。结果 术后皮瓣成功90例，失败3例，成功率为96．8％。供区3例[足母]甲瓣切取后创面不愈．经扩创、植皮后愈合。术后随访8个月～6年．平均2年，皮瓣质地、弹性及拇、手指外形功能良好．指腹皮瓣两点分辨觉达5～8mm。供区行走无影响。结论 选择不同类型的足部皮瓣游离移植是修复拇、手指不同部位皮肤缺损的理想、有效的治疗方法。

Repair of skin defect in the thumb and fingers by transfer of five types of free flaps from the foot

Objective To report the outcome of repairing skin defect in the thumb and fingers with five types of flaps from the foot. Methods From May 1987 to June 2003, a total of 93 cases of soft tissue defects of the thumb or fingers were treated. Five types of free flaps from the foot were employed to cover the defects. 27 cases of pulp defect were repaired by free pulp flap from the great toe, 8 cases of loss of nail and dorsal skin were repaired with free nail flap from the great or second toe. 48 cases of degloving injury of the thumb or fingers were reconstructed with wrap-around flap from the great or second toe. 6 cases of circumferential skin defect at the proximal phalanx level of the thumb or at the middle and/or proximal phalanx level of the fingers were repaired with semi-lunar flap from fibular side of the proximal great toe. 4 cases of large skin defect of two or three fingers were repaired with bifoliated or trifoliated flap from the dorsum of foot. Results 90 flaps survived while 3 flaps were lost, rendering a successful rate of 96.8 % . Healing problems were seen in the donor foot in 3 cases which were taken care of by debridement and skin graft. Follow - up period ranged from 8 months to 6 years with an average of 2 years. The blood supply, texture and elasticity of transferred flaps were excellent. The appearance of the repaired thumb and fingers was good. 2-point discrimination of the pulps was 5 to 8 mm. Conclusion Transfer of various types of flaps from the foot is an ideal method for repair of various kinds of skin defect in the thumb and fingers.