(足母)甲皮瓣供趾胫侧保留皮瓣的坏死原因

目的 探讨拇甲皮瓣供趾物胫侧保留皮瓣坏死原因。方法 １９８２年６月－１９９７年１２月对２６７例２７７例手指缺失患者采用拇甲皮瓣游离移植修复，按整形外科皮瓣设计原则，设计拇趾胫侧舌状皮瓣的基部在左足１０－６点，右足２－６点，宽宽为１．０－１．５ｃｍ，内含支配趾骨，关节等组织的血管与神经，保留骨膜。结果术后胫侧保留皮瓣坏死１３侧，坏死率为４．６９％，供皮瓣区植皮坏死７８侧，坏死率为２８．１％，大部分经

ANALYSIS OF THE CAUSES OF NECROSIS OF RETAINED FLAP ON TIBIAL SIDE AFTER TRANSPLANTATION OF THE GREAT TOE NAIL FLAP

OBJECTIVE: In order to investigate the causes of necrosis of the retained flap after transplantation of the great nail flap, according to the principle of plastic surgery, the following operation was designed. METHODS: A tongue-shaped great toe flap was made with its base on the tibial side of the great toe and the width of the base was 1 cm to 1.5 cm. The flap contained the supporting vessels and nerves and the periosteum was also preserved. RESULTS: From June 1982 to November 1997, the flap was used to repair 267 case, 277 fingers defects. After operation, the retained flap on the tibial side developed necrosis in 13 sides, an incidence of 4.69%, and in 78 sides, there was necrosis on the grafted skin on the donor site, an incidence of 28.7%. Most of the wounds healed after changing dressing, while 37 wounds healed from another skin graft. Of these cases, 178 cases had been followed up for 5 months to 16 years. It was found that the retained tibial tongue-shaped flap showed hyperplasia which extended to the weightbearing area of metatarso-phalangeal of great toe. It showed that the taking off of great toe nail flap according to first dorsal metatarsal artery (FDMA) I, II or III type, the incidence of development of necrosis of retained flap on tibial side showed no significant difference (P > 0.05). CONCLUSION: It was believed that the necrosis of the retained flap was not related to the FDMA classification but had relation with the design, operative technique and presence of infection.