急诊再造拇手指几种术式设计系列研究

目的 探讨修复手部复合组织缺损急诊再造拇、手指的最佳术式。方法 回顾性分析采用携带伴有Mu趾近节腓侧皮瓣的双侧趾蹼皮瓣、双侧足背皮瓣的双足3趾移植再造拇、手指49例；带两套血供的Mu趾甲皮瓣加第2、3足趾及前臂皮瓣组合移植再造拇、手指26例；带足背皮瓣的第2足趾或牌趾甲皮瓣加远隔游离皮瓣移植再造拇、手指20例；第2足趾趾甲皮瓣与掌背皮瓣瓦合移植再造拇、手指16例；部分第2、3足趾移植拇、手指指尖再造7l例；Mu趾甲皮瓣与第2足趾趾骨关节组合移植再造拇指22例；单纯四趾甲皮瓣移植再造拇指180例；单纯第2足趾移植再造拇、手指585例；废弃指异位再造手16例的术式设计及效果。结果 急诊一期组合组织及足趾移植985例，再造拇、手指1115指，再造拇、手指全部成活，成活率100％，感觉及运动功能恢复满意。结论 吻合血管的组合组织移植急诊再造拇、手指，具有最大限度的保留手部残存非失活组织及功能，最大限度修复重建手部功能的特点，是较理想的治疗方法，

A SERIES OF RESEARCH ON SEVERAL DESIGNS OF EMERGENCY THUMB AND FINGERS RECONSTRUCTION

Objective To explore an effective way to reconstruct thumb and finger in patients with composite hand tissue defects.Methods Forty-nine cases of composite tissue defect were repaired by transfer of 3 toe flaps with double-side toe-web and double-side back of foot.26 cases were reconstructed by transfer of first toe and nail flap with double blood supply and composite flap combined with second and third toes.20 cases were repaired by transfer of second toe or first toe and nail flap with foot-back flap plus distal free flap.16 cases were repaired by tile-shaped transfer of second toe and nail flap and palm back flap.Partial tranfters of second and third toes were used to repair fingertip in 71 cases.22 thumbs were reconstructed by transfer of first toe and nail flap and composite trnsfer of second toe and phalange joint.Transfer of single first toe and nail flap was used to reconstruct thumb in 180 cases and transfer of single second toe in 585 cases.Transplanation of abandoned fingers was used to reconstruct hand in 16 cases.Results Emergency transplantation of one-stage composite tissue and toe was used in 985 cases. 1 115 thumbs and fingers were reconstructed.The survival rate was 100%.The recovery of sensitive and kinetic functions was satisfactory.Conclusion Emergency thumb and finger reconstruction with composite tissue transplantation by microvascular anastomosis allows maximum salvage of residual tissue and function of hand.It features in utmost repair and functional reconstruction and is recommended as a relatively perfect treatment.