改良法(足母)甲皮瓣移植拇指远端缺损再造术

目的 分析改良(足母)甲皮瓣移植再造拇指远端缺损的方法,评价手术的安全性和对足部功能的影响.方法 对18例拇指远端缺损的患者,应用改良的(足母)甲皮瓣移植术进行拇指再造.其中Ⅰ类A区缺损5例,Ⅰ类B区缺损8例,Ⅱ类A区缺损5例.手术对躅甲皮瓣设计、骨骼处理等方面进行改进,针对跖背动脉的分型,采用不同的血管吻合方式.术后随访观察再造拇指的外观、感觉、关节活动度、握力和拇、示指捏力及满意度.根据足功能评定分析行走及弹跳功能,评价手术对足部功能的影响.结果 术后18例再造拇指全部存活,成功率达100%.术后随访8～26个月,再造拇指外观良好,接近健侧拇指.部分患者再造拇指指间关节保留良好的活动功能,手指捏力和握力达健侧的60%～90%.改良的手术方法对足部功能和外观的不良影响明显减小.足部并发症少,没有明显疼痛,外观、行走功能均良好.足功能评定显示:静止站立时足负重区、重心没有明显变化,站立负重区主要为躅趾趾腹、前足掌部及足跟;供足单足站立时重心轻度外移或不变,前后摆动身体重心位于两足之间,或轻度偏向健足.结论 改良的(足母)甲皮瓣移植术是一种安全的拇指再造方法,对供足功能影响更小.根据拇指缺损程度和血管情况的差异,选择不同的处理方法,可以进一步减少创伤,简化手术,增加手术的安全性.

Reconstruction of distal thumb by modified great toe wrap-around flap

Objective Modified partial great too wrap-around flap was transfefred to reconstruct the distal thumb.The safety of the operation and the impact on the donor foot were assessed. Methods Eighteen cases of composite defects of the distal thumb were involred.The defects were categorized as type ⅠA in 5 cases.type IB in 8 cases and type ⅡA in 5 cases.Modified great too wrap-around flap was used to repair the defects.Modification ineluded harvesting of the great toe wrap-around flap with most of the toe pulp reserved and improvement in the management of bones.Difierent configurations of vascular anastomosis were chosen based on the severed level of the thumb and the vessel pattem of the donor toe.Overall results were evaluatod in terms of the survival rate,the appearance,sensation and ioint movement of the reconstructed thumb,and the grip strength and key pinch.The impact on the donor foot was evaluated by walking,gait and jumping.Subjective satisfaction was also considered. Results All 18 transplanted thumbs survived.The successful rate was 100%.The incidence of complication was controlled to an acceptable range.Follow-up ranged from 8 to 26 months.The results showed that most patients gained a thumb with good function and ideal appearance.Good movement of the interphalangeal ioint was preserved in some eases.Grip strength and key pinch were 60%to 90%of that of the normal side.Impact on the donor foot was minor with limited complications.There was no pain.Gait analysis showed that walking was normal.There was no obvious change in wetght baring zone and center of mass at static standing.Weight bearing at standing was located at great toe pulp,front part of the sole and the heel.While standing on the donor foot only the center of mass was slightly shined laterally.While the body leaned back and forth,the center of mass was between the tow feet or slightly shifled to the heahhy foot.The questionnaire showed that all patients were satisfied with the results. Conclusions Modified great toe wrap-around flap is an ideal method for reconstruction of the distal thumb with limited influence on the donor foot.Difierent options should be chosen based on the severed level of the thumb and the vessel pattern of the donor too to minimize surgical trauma,simplify the procedure and enhance safety and success rate.