手指末节套脱伴甲床缺损的一期修复

目的 探讨应用携带附加筋膜瓣的指动脉岛状皮瓣联合断层甲床移植一期修复手指末节套脱伤的方法及疗效.方法 2005年6月至2008年10月,应用三种形式的携带附加筋膜瓣的指动脉岛状皮瓣联合断层甲床移植修复手指末节套脱伤9例,其中采用同指近节逆行岛状皮瓣6例,邻指中节顺行岛状皮瓣2例,结扎指总动脉邻指逆行岛状皮瓣1例.甲床移植来源为(母)趾7例,第二趾1例,撕脱甲床回植1例.结果 术后皮瓣及移植甲床全部存活,随访时间为3个月至2年,重建指腹外形饱满,两点分辨觉为6～12mm.3例新生指甲被覆完全,外形光滑、平整;2例新生指甲被覆超过4/5;3例超过1/2,与甲床贴附紧密;1例仅长出残留指甲.远指间关节活动度为30.～60°,供趾趾甲生长良好,行走功能正常.结论 携带附加筋膜瓣的指动脉岛状皮瓣联合断层甲床移植是修复手指末节套脱伤的一种可行方法.

Primary repair of degloving injury of the distal fingers with nail bed defect

Objective To introduce the operative methods of digital artery island flap with additional fascia flap combining split-thickness nail bed graft for repair of degloving injury of the distal finger, and evaluate the treatment outcomes. Methods From June 2005 to October 2008, three types of digital artery island flap with additional fascia flap combining split-thickness nail bed graft were clinically applied to repair degloving injury of the distal finger in 9 cases. The reversed island flap from the proximal phalanx of the same finger was applied in 6 cases. The forward island flap from the middle phalanx of the adjacent finger was applied in 2 cases, while the reversed island flap from the adjacent finger with ligation of the common digital artery was applied in 1 case.Nail bed grafts were taken from the great toe in 7 cases, the second toe in 1 case, and the avulsed nail bed in 1 case. Results All flaps and nail bed grafts survived. Postoperative follow-up period ranged from 3 months to 2 years. The appearance of the repaired pulps were well-stacked, with 2-PD recovered to 6 to 12 mm. The newly grown nail was flat and smooth, with complete coverage in 3 cases. In 2 cases coverage of the nail bed by the newly grown nail surpassed 4/5, while the coverage was over 1/2 in another 3 cases. All these newly grown nails attached to the nail bed closely. There was only 1 case that had incomplete nail. The range of motion of the distal interphalangeal joint was 30° to 60°. The nail of donor toe grew well, and the function of walking was normal.Conclusion Digital artery island flap with additional fascia flap combining split-thickness nail bed graft is good method in repair of degloving injury of the distal finger.