足趾复合组织游离移植修复手指复合组织缺损

目的 :探讨足趾复合组织移植修复手指复合组织缺损的方法。方法 :采用以下 7种方法治疗病人 2 1例 :带第 1跖背动脉的游离甲瓣、远节趾骨背侧部分趾骨并肌腱止点、背侧关节囊、伸肌腱、背侧皮肤移植修复手指指甲、伸肌腱和神经、皮肤缺损 2例 ;游离第 2足趾携带胫侧固有动脉、神经的近侧趾间关节复合组织 ,移植修复中指远侧指间关节复合组织缺损 ,同时利用第 2足趾中末节及腓侧固有动脉及神经再造环指末节 1例 ;第 2跖趾关节同时携带第 2跖骨、伸趾肌腱与足背皮瓣移植一期修复掌指关节、掌骨、伸肌腱与皮肤复合组织缺损 3例 ;第 1跖背动脉携带第 2足趾甲瓣并伸指肌腱修复拇指指甲、伸肌腱并神经、皮肤缺损 5例 ;第 1跖背动脉携带第 2跖趾关节、趾固有动脉携带第 2足趾近侧趾间关节移植重建两个相邻的掌指关节并皮肤缺损 2例 ;跖趾关节、趾近侧趾间关节复合组织移植 ,分别修复掌指关节或指间关节并复合组织缺损 6例。足背皮瓣、携带第 1跖背动脉的第 2足趾、同侧趾腓侧皮瓣再造全长手指 2例。结果 :应用 2 1例成功 ,随访 6个月～ 5年手指感觉恢复达S3 + ～S4;关节活动度 :掌指关节活动范围 2 0°～ 80° ;近指间关节活动范围 3 0°～ 90° ;远指间关节活动范围 5°～ 3 0°。结论 :带血供足趾复合组

Repair of Compound Defect in the Hand by Compound Flap Transfer of the Foot

Objective:To study the outcome of repair of compound defect of the hand by compound flap transfer of the foot.Method: Twenty-one cases with seven kinds of compound defect in the hand were treated surgically. Among them, two cases with defect of skin and extensor tendon in the dorsum of hand were repaired by dorsalis pedis flap with tendons of great toe; one case with joint defect of middle finger and absent of ring finger were reconstructed with tibial segmental osteo-onychocutaneous flap and minor details by the second toe; three cases with defect of joint and extensor tendon were repaired by joint and extensor tendon of the second toe and dorsal flap of foot; five cases with defect of skin and extensor tendon in the dorsum of hand were repaired by dorsalis pedis flap with tendons of the second toe; two cases with defect of two joints in two fingers were repaired by two joints supplied by different blood vessel of second toe; six cases with defect of joint and skin were repaired by compound tissue of toe; two cases with defect of finger were repired by the second toe and dorsalis pedis flap. Results:All cases were successful postoperatively, with satisfactory effect and with better apperance. Conclusions:The compound flap transfer is an ideal method in repair of compound defect in the hand.