改良(足母)趾腓侧皮瓣修复拇手指指腹缺损

目的介绍改良躅趾腓侧皮瓣修复拇、手指指腹缺损的手术方法。方法对15例拇、手指指腹缺损的患者，采用改良的躅趾腓侧皮瓣移植修复。该皮瓣在传统躅趾腓侧皮瓣设计方法基础上，将皮瓣腓侧缘及近端分别向背侧及趾蹼侧移动，从而避开口径细小又紧贴于皮下的躅趾腓侧浅静脉，直接游离第一跖背浅静脉；皮瓣的动脉和神经游离仍以常规方式进行。结果术后15例皮瓣全部成活，未发生动、静脉危象。12例获得4～11个月随访，3例失访。手功能评定：优10例，良2例。皮瓣两点分辨觉为4～8mm，12例对皮瓣外形满意。供区行走无影响，步态正常。10例对供区外观满意，2例欠满意，其中1例蹲趾腓侧偶有触痛。结论应用改良躅趾腓侧皮瓣可显著降低手术难度，提高成功率。

Modified fibular hallux flap for repair of finger pulp defects

Objective Modified fibular haflux flap was designed to overcome the difficulty of superficial vein detaching. Methods Modified fibular hallux flap was designed by shifting the flap dorsally and towards the first web. With this modifying, the tiny superficial vein on fibular side of the big toe was included in the flap. The first metatarsal vein of the flap could be easily harvested at the first web. The artery and nerve were harvested in routine procedure. 15 fingers of distal volar skin defect were covered with these modified flaps. The harvesting time, the superficial vein harvesting process, and the survival results of flaps and donor skin graft were recorded. The functions of donor and recipient sites were evaluated. Results The harvesting time was shortened by 30%. The anatomic position of the first metatarsal vein was constant, which made the vein harvesting easier. All flap and skin-graft survived with satisfactory function. Conclusions Modified fibular hallux flap provided easier harvesting procedure and shorter operation time.