重视再造拇指及供足外观的(足母)甲皮瓣移植

目的 在提高(足母)甲皮瓣移植再造拇指功能的基础上进一步改善外形,减少对供足的损害.方法 对39例拇指缺损的患者,采用Morrison及改良(足母)甲皮瓣方法移植再造拇指,供区创面修复采用游离植皮30例、皮瓣加游离植皮8例、皮瓣1例.结果 移植(足母)甲皮瓣39例,存活38例,失败1例.术后随访3个月至2年,再造拇指均有不同程度的直径缩小、皮肤变薄、指纹变浅现象,萎缩以指甲部最为明显.指腹两点分辨觉平均为10mm.(足母)趾创面4例需再次植皮或咬除部分趾骨,缝合后愈合;其余创面全部愈合.3个月内大多数患者行走时感到轻度疼痛;随访半年以上者疼痛逐渐消失,站立、行走、跑步均无明显异常.结论 (足母)甲皮瓣移植术中注意骨骼的设计、甲床的切取及多根神经的缝接,术后可明显改善再造拇指的外形.改良(足母)甲皮瓣的切取方法能减少对供区功能的损害,改善外观.

The aesthetic wrap-around flap technique for thumb reconstruction

Objective In addition to restoring thumb function in wrap-around flap transfer for thumb reconstruction, modification was done to improve the appearance of the reconstructed thumb and minimize donor site morbidity. Methods Thirty-nine thumb defects were reconstructed using Morrison' s procedure and modified great toe wrap-around flap. The donor site was covered with free skin graft in 30 cases, with flap and skin graft in 8 cases and with flap in 1 case. Results Of the 39 transferred wrap-around flaps, 38 survived. One case failed. Postoperative follow up ranged from 3 months to 2 years. The reconstructed thumbs presented various degrees of reduction in diameters, thin skin and shallow fingerprint. Atrophy was most prominent in the nails. The mean static 2-point discrimination was 10 mm in the pulps. In 4 cases secondary skin graft or closure after partial phalanx resection was required to heal the wound of the donor great toe site. Wound healing was achieved in donor sites of the other cases. Most patients experienced mild pain of the donor foot during ambulation within the first 3 months after the surgery. Pain gradually disappeared when follow up interval exceeded 6 months. Standing, walking and running were near normal. Conclusion Attention should be paid to the design of bone construct, nail harvest and multiple nerve coaptations in wrap-around flap transfer. Modified flap harvest procedure reduces damage to the donor site and improves appearance of the reconstructed thumb.