拇手指再造供区(足母)趾坏死的原因及预防措施

目的 对3例拇手指再造供区(足母)趾坏死的原因进行分析并提出预防措施.方法 自1998年2月至2005年2月,在我院行游离足趾移植再造拇手指中,3例供区(足母)趾部分坏死.通过分析(足母)趾血供的来源及术中采用血管阻断实验,分析供区(足母)趾部分坏死的原因,提出预防措施.结果 3例供区(足母)趾部分坏死,第1跖骨背动脉均为Ⅲ型,术中均采用足背动脉-足底深动脉-第1趾足底总动脉这一途径来切取第2趾.发现供区(足母)趾坏死时间为术后8～21 h.术中同时损伤(足母)趾腓侧趾背动脉、腓侧跖底动脉,将严重影响供区(足母)趾血液循环,术后供区包扎过紧、观察不到位,是导致供区(足母)趾坏死不可忽视的原因.结论 第1跖骨背动脉Ⅲ型,解剖足底动脉于跖底的"X"形交叉处,切取第2足趾,更易影响供区(足母)趾血运.采用吻合足底深动脉与跖底动脉或足背动脉-第2跖背动脉-趾动脉为血供切取足趾,可有效预防供区(足母)趾血运被破坏;术中、术后严密观察供区足的血运情况,及时解除(足母)趾压迫,是预防供区(足母)趾坏死的有效途径.

Abstract：

Objective To analyze the causes of necrosis of the donor great toe in 3 cases of toe-to-hand transfer and propose the proper preventive measures.Methods Among all the toe-to-hand transfers done from February 1998 to February 2005, partial necrosis of the donor great toe occurred in 3 cases.Blood supply of the transferred toe and the intraoperative vessel occlusion test was reviewed and analyzed to define causes of the necrosis, and propose preventive measures accordingly.Results The dorsal artery of the great toe was type Ⅲ in all 3 cases.Intraoperatively the second toe was harvested based on the dorsalis pedis artery, deep plantar artery, plantar artery of the first toe.Donor great toe necrosis was observed 8 to 21 hours postoperatively.Intraoperative inadvertent injury of the dorsal great toe fibular artery and fibular plantar metatarsal artery, tight dressing of the donor site after the surgery, and poor postoperative monitoring could have contributed to the toe necrosis.Conclusion Type Ⅲ of the dorsal artery of the great toe, anatomical X cross and resection of the second toe could easily affect blood supply to the donor great toe.Anastomosis of the deep plantar artery and the plantar metatarsal artery, or harvest of the toe based on the dorsalis pedis artery, second dorsal metatarsal artery,digital artery axis can effectively prevent damage of the blood flow.Intra-and post-operative close monitoring of the donor site circulation and timely decompression of the great toe were effective ways to prevent great toe necrosis.

Causes of necrosis of the donor great toe in toe-to-hand transfer and its preventive measures

Objective To analyze the causes of necrosis of the donor great toe in 3 cases of toe-to-hand transfer and propose the proper preventive measures.Methods Among all the toe-to-hand transfers done from February 1998 to February 2005, partial necrosis of the donor great toe occurred in 3 cases.Blood supply of the transferred toe and the intraoperative vessel occlusion test was reviewed and analyzed to define causes of the necrosis, and propose preventive measures accordingly.Results The dorsal artery of the great toe was type Ⅲ in all 3 cases.Intraoperatively the second toe was harvested based on the dorsalis pedis artery, deep plantar artery, plantar artery of the first toe.Donor great toe necrosis was observed 8 to 21 hours postoperatively.Intraoperative inadvertent injury of the dorsal great toe fibular artery and fibular plantar metatarsal artery, tight dressing of the donor site after the surgery, and poor postoperative monitoring could have contributed to the toe necrosis.Conclusion Type Ⅲ of the dorsal artery of the great toe, anatomical X cross and resection of the second toe could easily affect blood supply to the donor great toe.Anastomosis of the deep plantar artery and the plantar metatarsal artery, or harvest of the toe based on the dorsalis pedis artery, second dorsal metatarsal artery,digital artery axis can effectively prevent damage of the blood flow.Intra-and post-operative close monitoring of the donor site circulation and timely decompression of the great toe were effective ways to prevent great toe necrosis.