部分踇甲瓣和第二趾腹皮瓣联合修复指脱套伤

目的探讨2～4指全指脱套伤的修复方法,寻找最佳术式. 方法切取携带足背皮瓣的部分踇趾甲皮瓣修复手指背侧和部分掌侧,第二趾侧腹皮瓣修复指掌侧软组织缺损,形成一个血管蒂的部分踇趾甲皮瓣及第二趾侧腹皮瓣修复全手指脱套伤. 结果临床应用6例9指全部成活,受区伤口Ⅰ期愈合8指,其中有1例为双侧踇甲瓣及第二趾侧腹皮瓣修复示、中指,因中指近指间关节(DIP)有脱位,末节指骨坏死,死骨摘除,3个月后伤口愈合,皮瓣成活,原修复指甲及甲床也坏死.供区除1例踇甲瓣供区植皮部分坏死外,余Ⅰ期愈合,术后随访6～14个月,掌指关节活动度60°～70°,近指间关节活动度40°～50°,指腹饱满,两点辨别觉8～12 mm,外形逼真,指甲生长良好,有1指指甲萎缩,1指指甲已缺损,供区行走良好,无疼痛及足部肿胀,植皮处肤色深,关节活动无影响. 结论部分踇甲瓣联合第二趾腹皮瓣是一种修复全手指脱套伤的理想方法.

The wrap-round la flap with part toenail combined with the second simepulp flap for repair of total avulsion of fingers

Objective To explore the method for repair of total avulsion of 2~4 fingers and to find the best procedure. Methods The wrap-round flap with part toenail combind with the dorsal pedical flap to repair soft tissue defect of the dorsal of finger and part of the palmar of finger, the second simepulp flap to repair soft tissue defect of the palmar of finger,transfer of two tissues with one pedicle to repair total avulsion of 2~4 fingers. Results All of 9 composite transplants in 6 cases were survived,the received areas were primary healing in 8 finger,1 case repaired by the bilateral wrap-round flaps and second simepulp flaps for index and middle finger,the distal phalanx of middle finger necrosis because of dislocation of DIP,3 months later,injury healed after the necrosis of phalanx excised,but the nail and the nail bed were dead.Except 1 case which the grafted skin necrotized in the donor area of the big toe,the rest had primary healing.All cases were followed up 6~14 months,the activity of joints were: MP 0-70,PIP 0-40.The repaired pulps had excellent appearance,the nail was fine,1 finger's mail was atrophy and 1 finger's nail was defect.The donor area had good fountion without pain and edema,the grafted skin had normal color and the activity of joints were nomal. Conclusion The wrap-round flap with part toenail combined with the second simepulp flap is a good approach in treatment of the skin avulsion injury in the finger.