两种方法修复拇趾皮肤软组织缺损的比较

目的比较第1跖背动脉逆行岛状皮瓣和足底内侧动脉逆行岛状皮瓣修复拇趾皮肤软组织缺损的成功率和功能效果．探索和优化拇趾皮肤软组织缺损修复的技术方法。方法分别采用第1跖背动脉逆行岛状皮瓣（n=12）和足底内侧逆行岛状皮瓣（n=15）修复拇趾软组织缺损，对比两组的手术成功率和术后并发症。以足行走负重功能、皮瓣外形、颜色、抗压耐磨、皮肤感觉为参数评价和对比两组病例术后2年的疗效．结果第1跖背动脉逆行岛状皮瓣组12例全部成活，无手术并发症发生：足底内侧动脉逆行岛状皮瓣组15例发生静脉危象导致皮瓣坏死1例，皮瓣边缘部分缺血坏死造成延迟愈合1倒，无其他手术并发症：两组病例术后2年在行走负重功能、皮瓣外形、颜色方面无显著性差异．P〉0．05；皮肤感觉：两组有显著性差异，P〈O．05；抗压耐磨性：两组有显著性差异，P〈0．05。结论第1跖背动脉逆行岛状皮瓣和足底内侧动脉逆行岛状皮瓣修复拇趾软组织缺损均有较高的成功率和较低并发症发生率，前者皮肤感觉好，后者抗压耐磨性强。

Comparison of two methods in reconstruction of the great toe soft tissue defect

Objective To compare the survival and functional outcomes of the reverse transplantation of the medial plantar flap and the first dorsal metatarsal artery flap used in reconstruction of the great toe soft tissue defects, in order to explore and optimize the reconstructive techniques. Methods The reverse transplantation of the medial plantar flap （n=15） and the first dorsal metatarsal artery flap （n=12） were used to repair the great toe soft tissue defects. Surgical success rate were compared between these two groups. The function of weight-bearing walking, the shape, color, feeling, compressive strength and abrasion resistance of flap were evaluated and compared between two groups 2 years after operation. Results All flaps survived in 12 cases of the first dorsal metatarsal artery flap group, without surgical complications; 1 skin island necrosis as a results of venous crisis and 1 marginal necrosis that result in wound dehiscence occurred in 15 cases of the medial plantar flap group, without other surgical complications. The function of weight-bearing walking and the flap shape and color were comparable between the two group, P 〉0.05; The feeling, compressive strength and abrasion resistance of flap were different between the two group, P 〈0.05. Conclusion Both of the reverse transplantation of the medial plantar flap and the first dorsal metatarsal artery flap are good alternative to reconstruction of the great toe soft tissue defects, with high flap survival rate and low surgical complication. The first dorsal metatarsal artery flap is good alternative for reconstruction feeling, and the other is good for compressive strength and abrasion resistance.