改良第一跖背逆行皮瓣修复拇趾背侧烧伤创面

目的探讨第一跖背逆行皮瓣术式的可行性及其对拇趾背侧烧伤创面的治疗效果。方法2004年4月-2010年6月，笔者对6例拇趾背侧烧伤的患者，应用第一跖背逆行皮瓣进行修复。对于第一跖背血管为Gilbert Ⅰ或Ⅱ型的患者，形成靠第一跖背血管远端及其于跖趾关节附近．发出的较大皮支和腓深神经皮支及其营养血管共同营养的第一跖背逆行皮瓣；对于第一跖背血管为GilbertⅢ型者，形成仅靠腓深神经皮支及其营养血管营养的第一跖背逆行皮瓣。皮瓣面积为4cm×3cm～5cm×4cm，供瓣区移植皮片修复。结果本组移位皮瓣全部成活，切口一次性愈合。4例患者获得1个月-1年的随访，皮瓣色泽、质地较好，拇趾背侧和供瓣区的外形及功能较满意。结论本术式降低了分离难度，还大大降低了对第一跖背血管和第一骨间背侧肌的破坏程度，且可避免遇到Gilbert Ⅲ型血管时放弃手术的缺憾，从而扩大了皮瓣的应用范围，是修复拇趾背侧烧伤的理想选择。

Application of Modified Reverse Dorsal Metatarsal Artery Flap in Repairing Burn Wound of Dorsal Side of Great Toe

Objective To investigate the feasibility and therapeutic effect of modified reverse dorsal metatarsal artery flap in treating the burn wound of dorsal side of great toe. Methods From Apr. 2004 to Jun. 2010,6 patients who suffered from the burn wound of dorsal side of great toe were repaired with modified reverse dorsal metatarsal artery flaps. For patients with Gilbert type I or lI artery, we designed the reverse dorsal metatarsal artery flap supplied by the distal part of the first dorsal metatarsal artery and its a larger branch in the vicinity of metatarsophalangeal joint combined with cutaneous branch of deep peroneal nerve and its nutrient vessels. For patients with Gilbert type Ⅲ artery,we designed the reverse dorsal metatarsal artery flap supplied only by cutaneous branch of deep peroneal nerve and its nutrient vessels. The size of flaps ranged from 4 cm × 3 cm to 5 cm × 4 cm. The donor sites were closed by free skin grafting. Results All the modified flaps survived completely. All patients were treated with primary healing. 4 patients were followed up 1 to 12 months. The contour of modified flap was good. The cosmetic and functional results were satisfactory both in donor sites and in recipient areas. Conclusion The modified procedure not only lowered the difficulty of operation,but also greatly minimized the degree of damage to the first dorsal metatarsal artery and the first dorsal interosseous muscle. In addition,it can also avoid the regret of abandoning operation for lack of the first dorsal metatarsal artery. Therefore, it was an ideal option for repair of the Ⅳ degree burn wound of dorsal great toe.