拇、手指缺损再造396例临床分析

目的 评估几种组织移植在拇、手指再造中作用。方法 利用长蒂法第二足趾移植136例,短蒂法足趾移植76例,拇甲瓣加髂骨或第二趾骨25例,单纯拇甲瓣37例,带足背皮瓣的第二足趾21例,带足背皮瓣的拇甲瓣16例,手指移位再植再造拇指27例,中环指双岛状皮瓣再造拇指6例,前臂逆行岛状骨皮瓣12例,食指背侧和环指尺侧皮瓣6例,腹股沟骨皮瓣34例。结果 成活383例,成活率96.8％,外形功能满意。结论 足趾和拇甲瓣移植是比较理想方法,应争取一期再造,利用短蒂法再造可缩短手术时间,残指移位可废指利用,指侧岛状皮瓣可解决腹股沟皮瓣再造拇指后拇指缺少感觉和血供差的问题。

Clinical Analysis on 396 Cases with Thumb and Finger Defect Reconstruction

Objective To summarize the experience on 396 cases of thumb and finger reconstruction. Methods We utilized long-pedicle graft(136 cases), short-pedicle graft(76 cases), transplantation of hallucal nail flap coupled with iliac bone or the second phalanx(25 cases), pure hallucal nail flap graft(37 cases), transplantation of the second toe with dorsal skin flap of foot(21 cases), transplantation of hallucal nail flap with dorsal skin flap of foot(16 cases), thumb reconstruction by finger displacement and retransplantation(27 cases), thumb reconstrution by dual-island-shaped skin flap transplantation of the fourth finger(6 cases), retrograde transplantation of island-shaped skin flap in foream(12 cases), transplantation of skin flap in the dorsal part of the first finger and ulnar part of the fourth finger, inguinal skin flap transplantation(34 cases). Results There were 383 cases in survival and the survival rate was 96.8%. We got satisfactory results in the appearance and function of the fingers and toes. Conclusion Transplantation of toes and hallucal nail flap is more optinal measure.We should make effort for primary reconstruction.The measure of short-pedicle graft can shorten operating time. The patients can make the disabled fingers and toes play their roles after displacement and reconstruction. Transplantation of island-shaped skin flap in lateral part of fingers can solve the problems which are anesthesia and poor blood supply in thumb after reconstruction of thumb with inguinal skin flap.