CAJ | 학술논문

目的介绍足部皮瓣治疗多指指背复合组织缺损的临床应用.方法临床应用7例19指,均为2～4指指背复合组织缺损伤,并伴有伸肌腱缺损及指骨或指间关节外露,并指后指背创面大小为5.0 cm×1.5 cm～9.0 cm×2.5 cm.以(足母)趾腓侧、跖侧界线及第一、二跖骨间隙为轴线设计皮瓣,形状同并指后指背创面,面积稍大.皮瓣切取时携带大隐静脉、趾背静脉和第一跖背、跖底动脉及神经,分别与相应患指指背静脉及指固有动脉、神经吻合.保留趾短或趾长伸肌腱于皮瓣内,以修复指背缺失的伸肌腱.结果术后皮瓣全部存活,皮瓣质地及外形好,皮瓣两点分辨觉为6～8mm.患指伸指功能得到重建,主、被动屈伸活动恢复满意.足部供区瘢痕轻微,功能良好,外形美观.结论足背、趾蹼及(足母)趾腓侧复合皮瓣是治疗多指指背复合组织缺损较好的方案之一.
목적 개소족부피판치료다지지배복합조직결손적림상응용.방법 림상응용7례19지,균위2～4지지배복합조직결손상,병반유신기건결손급지골혹지간관절외로,병지후지배창면대소위5.0 cm×1.5 cm～9.0 cm×2.5 cm.이(족모)지비측、척측계선급제일、이척골간극위축선설계피판,형상동병지후지배창면,면적초대.피판절취시휴대대은정맥、지배정맥화제일척배、척저동맥급신경,분별여상응환지지배정맥급지고유동맥、신경문합.보류지단혹지장신기건우피판내,이수복지배결실적신기건.결과 술후피판전부존활,피판질지급외형호,피판량점분변각위6～8mm.환지신지공능득도중건,주、피동굴신활동회복만의.족부공구반흔경미,공능량호,외형미관.결론 족배、지복급(족모)지비측복합피판시치료다지지배복합조직결손교호적방안지일.
Objective To introduce the clinical application of composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects. Methods This method was applied to treat 7 cases and 19 fingers. All the cases involved complex dorsal soft tissue defect of 2 to 4 fingers with extensor tendons missing and phalanx or interphalangeal joint exposed. The combined soft tissue defect area was 5.0cm×1.5cm to 9.0 cm× 2.5 cm. The flaps were designed along the axis extending from the fibular and plantar margin of the great toe to the interspace between the first and second metatarsal bones. The flap was slightly larger than the dorsal finger defect combined and the shape of the flap was the same as the combined defect. The greater saphenous vein, dorsal digital veins and dorsal metatarsal or plantar metatarsal artery and nerves were included in the flap. They were sutured with dorsal digital veins, digital artery and nerves, respectively. Extensor digitorum brevis tendons and extensor digitorum longus tendons were included in the flap to reconstruct the missing tendons. Results All the flaps survived with good texture and good appearance. Two-point discrimination recovered 6 to 8 mm. Finger extension function was restored, and active finger flexion and extension recovered satisfactorily. The donor feet were with slight scar, good appearance and normal function. Conclusion Combined dorsalis pedis,toe web and great toe fibular flap including extensor digitorum brevis and extensor digitorum longus tendon is a good option to treat multi-finger dorsal complex defects.