拇甲瓣移植再造拇指术后的感觉功能恢复

目的研究拇甲瓣再造拇指术后的感觉功能恢复情况。方法2003年1月-2009年6月共行19例坶甲瓣移植再造拇指术．感觉功能的测量：行健侧坶趾趾尖及健侧对应指尖感觉功能测量．与术后指尖感觉功能测量的结果相比较，包括温度觉、痛觉、触觉、振动觉、两点辨别觉。结果术后随访12~58个月，平均26个月，皮瓣全部成活，指体外形满意，手指活动功能优良；感觉功能恢复结果：温度觉恢复最好，痛觉其次，触觉和振动觉达到正常70％；两点辨别觉恢复最差，两点辨别觉：健侧指尖（3．0±1．0）mm，健侧坶趾趾尖（6．5±2．5）mm，再造拇指术后指尖（9．0±5．0）mm。结论坶甲瓣再造拇指，外形逼真，功能优良；再造手指感觉功能恢复总体满意，但不完全并有选择性，再造手指的感觉功能更接近足趾而非手指。

Recovery of sensation after thumb reconstructions with the free great toe wrap-around flap

Objective To study recovery of sensation after thumb reconstructions with the free great toe wrap-around flap. Methods Total 19 patients accepted thumb reconstruction with the free great toe wrap-around flap between January 2003 and June 2009. we measured the sensation of the plantar side of the toe tip before transplantation and the palmar side of the contralateral corresponding normal fingertip. We also measured the sensation of the palmar side of the fingertip after toe transplantation. Results All patients were followed up 12-58 months with an average of 26 months. All flaps survived and the reconstructed thumbs had satisfactory appearance and range of motion. Temperature sensation showed nearly complete recovery. Pinprick sensation was next in good recovery. Both vibratory and touch sensations achieved about 70% of normal sensation. Two-point discrimination showed the worst recovery. The mean two-point discrimination was （3.0±1.0）mm for normal finger, （6.5±2.5）mm for normal toe and （9.0±5.0）mm for transplanted toe. ConcLusion Using the free great toe wrap-around flap for thumb reconstruction, aesthetic and functional thumbs can be achieved. Although incomplete and selective, sensory function recovery of the transplanted toes was in general satisfactory and appeared to be more like toes than fingers.