蹲甲皮瓣移植再造拇指术后再造拇指指甲的远期随访

目的 探讨游离甲皮瓣移植再造拇指术后再造拇指指甲的远期改变.方法 对行 甲皮瓣移植再造拇指的患者进行随访,观察再造拇指指甲外观,测量其宽度及长度,并与健侧拇指及供趾健侧趾进行对比,并进行统计学分析.结果 19例患者获得随访,随访时间7～182个月,平均40个月.所有患者行拇指再造时均未作甲床修整.随访发现再造拇指指甲虽然均无畸形,外观佳,但指甲长度和宽度均有缩小,曲度增大.健侧趾甲床宽度为(19.3±2.4)mm,x±s,下同],再造拇指甲床宽度缩小为(17.1±2.3)mm,两者差异有高度统计学意义(t=5.95,P＜0.01);再造拇指的甲床宽度接近健侧拇指甲床宽度(17.1±1.7)mm,两者差异无统计学意义(t=0.00,P＞0.05),但由于再造拇指甲床曲度明显增大,因而显得比健侧拇指甲床更小.再造拇指的甲床长度缩减更加明显,其测量值为(12.2±2.2)mm,与健侧趾甲床长度(14.7±2.4)mm和健侧拇指甲床长度(15.4±3.2)mm相比,差异均有高度统计学意义(t分别=5.72和4.27,P均＜0.01).采用原套脱伤拇指指骨或髂骨植骨作为骨性支撑的两组再造拇指的甲床大小差异无统计学意义.结论 游离甲皮瓣移植再造拇指术后再造拇指的甲床长度和宽度均会发生明显的萎缩,且由于指甲曲度增大,显得比健侧拇指指甲还小,因此术中无需对供趾甲床进行修剪.

Long-term follow up of the nails of the thumbs reconstructed with the wrap-around flap

Objective To investigate the long-term changes of the nails of the thumbs reconstructed with free wrap-around flap. Methods Patients who underwent thumb reconstruction with wrap-around flap were followed up. The nails of the reconstructed thumbs were examined, and their widths and lengths were measured and compared with those of the uninjured thumbs and the contralateral intact big toes. Results A total of 19 cases were followed up for an average period of d0 months (range 7 to 182 months). None of the nail beds was trimmed during the surgery. Although all the nails of the reconstructed thumbs had good appearance without any deformity, most of them decreased in beth width and length with increased curvatures. The average nail bed width of the reconstructed thumbs (17.1±2.3) mm decreased compared with that of the intact big toes (19.3±2.4) mm, and the difference was statistically significant (t =5. 95,P ＜0.01). The difference of the average nail bed width between the reconstructed and the uninjured thumbs (17.1 ±1.7) mm was not statistically significant (t=0.00,P ＞0.05 ), but the nails of the reconstructed thumbs had increased curvature, which created an impression that they were narrower than those of the uninjured ones. The average nail bed length of the reconstructed thumbs (12.2 ±2.2) mm decreased more significantly, and it was smaller than those of the intact big toes (14.7±2.4) mm and the uninjured thumbs ( 15.4 ±3.2) mm, both with statistical significance (t=5.72, P＜0.01 and t= 4.27,P ＜0.01 respectively). The nail beds of the reconstructed thumbs with the degloved thumb phalanges as the underlying bones were neither longer nor wider than those with the iliac crest as the underlying bones. Conclusion The naris of the thumbs reconstructed with wrap-around flap would become remarkably atrophic beth in width and length postoperatively. In addition they look smaller than those of the uninjured thumbs clue to their increased curvatures, so it was not necessary to trim the transferred nail beds intraoperatively.