组织瓣联合移植一期重建拇指和虎口

目的介绍组织瓣联合移植重建拇指和虎口的疗效。方法临床应用２或３个组织瓣联合移植，一期重建拇指和虎口复合组织缺损９例。结果术后平均随访３年，再造拇指感觉均已恢复，两点辨别觉４～７ｍｍ。拇指均恢复了持物和对指、对掌功能，效果满意。７例同时再造虎口者，虎口开大幅度正常或接近正常，另２例达健侧的６０％～７０％。结论应用吻合血管的组织瓣联合移植，一期重建拇指和虎口是个疗程短、疗效好的方法。

One stage reconstruction of the thumb and the first web space with combined flap transplantation

Objective To evaluate the treatment outcome of combined transplantation of vascularized tissue flaps for reconstruction of the thumb and the first web space in one stage. Methods Combined transplantation of 2 or 3 tissue flaps was simultaneously performed to repair defect of the thumb and the first web space in 9 cases.The second toe or its composite flap was used to repair the circumferential avulsion of the thumb; the skin flap from the dorsum of the index finger was used to repair a small sized defect of the first web space;the reversed island flap based on the posterior interosseous artery was used to repair a middle sized of the first web space;the free flap based on the interior epigastric artery or the anterolateral femoral flap was used to repair a large sized defect of the first web space. All patients were followed inferior up for an average of 3 years. Results Sensory restoration was obtained in all reconstructed thumbs, with 2 PD of 4 to 7 mm. The thumbs also showed satisfactory restoration of holding and opponens function. The reconstructed first web space were widened to normal or near normal width in 7 cases, and reached 60 % to 70 % of the size of the healthy side in the other 2 cases. Conclusions It is of shortened treatment process and satisfactory result to reconstruct the thumb and the first web space with combined transplantation of vascularized tissue flaps.