顺行岛状皮瓣与甲床回植术治疗指尖离断伤

目的探讨急诊采用顺行岛状皮瓣与甲床回植治疗指尖离断伤的显微修复方法。方法对10例指尖离断伤的患者,急诊采用顺行岛状皮瓣与甲床回植进行显微修复。指尖离断平面分别位于甲中及甲根部平面。结果术后10例皮瓣和回植甲床均全部存活,术后随访时间为6～12个月。指端外观满意,皮瓣质地柔软,手指无明显触痛,活动功能正常。术后指甲较术前平均延长4．0～6．0mm,其中指甲与甲床完全附着8例,4／5附着2例。9例指甲光滑、无压痛,1例出现钩甲畸形。结论对甲根以远指尖离断无再植条件者,采用顺行岛状皮瓣修复手指残端,可保留手指的长度;将游离甲床回植,并加压包扎,可修复部分甲床,改善手指远端的外形。

Emergency treatmnent of fingertip amputation with forward flow axial island flap and nail replantation

Objective To introduce a new procedure of microsurgical repair of fingertip amputation. Methods Ten cases of fingertip amputation were treated with forward flow axial flap and nail replantation. The severance level was at either mid-nail or nail base. Results All flaps and nails of the 10 cases survived completely. After 6-12 months postoperative follow-up, the appearance of the fingertip was good. The flap was supple. There was no finger tenderness and impairment of finger movement. Finger nail extended about 5.0 mm on average after the operation. Conclusion When there are no suitable digital arteries for microsurgical fingertip replantation, digit function and length can be retained with forward flow axial island flap. The nail and nail bed can be trimmed and re-attached to gain some nail growth for better appearance.