中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2011年
4期
269-271
,共3页
指%再造%(足母)甲瓣%显微外科
指%再造%(足母)甲瓣%顯微外科
지%재조%(족모)갑판%현미외과
Finger%Reconstruction%Hallux nail flap%Microsurgery
目的 介绍手指Ⅳ～Ⅵ度缺损的全形再造方法。 方法 自1998年12月至2010年12月，对手指Ⅳ度缺损63例85指,Ⅴ度缺损31例49指，Ⅵ度缺损17例23指进行了手指全形再造。保留4个足趾的，（足母）甲瓣供区用2趾甲皮瓣修复；保留5个足趾的，（足母）甲瓣供区用皮瓣移位或移植来修复，第2足趾关节供区取髂骨充填。手指Ⅳ度缺损和部分Ⅴ度缺损，采用（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣，串1条髂骨再串第2趾近侧趾间关节的方法再造。部分近节指骨缺失长度较长的Ⅴ度缺损手指，采用（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣，串l条髂骨，再串第2趾近侧趾间关节，最后还要在近节指骨残端与移植的第2趾近侧趾间关节间再串l条髂骨的方法再造。Ⅵ度缺损的手指，采用以下顺序串连：（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣，串l条髂骨，串第2趾近侧趾间关节重建手指近指间关节，串l条髂骨重建近节指骨，串第2跖趾关节重建掌指关节的方法再造。 结果 再造手指157指全部成活。平均随访7个月～11年，其中75指行二期整形手术。再造手指外形美观，再造指指腹两点辨别觉为5～12mm。67指行术后肌腱松解手术，再造指间关节活动度：伸-10°～10°，屈55°～ 100°，平均81°。结论 手指Ⅳ度至Ⅵ度缺损全形再造，再造的手指兼具美观外形与良好运动功能，缺点是手术较复杂。
目的 介紹手指Ⅳ～Ⅵ度缺損的全形再造方法。 方法 自1998年12月至2010年12月，對手指Ⅳ度缺損63例85指,Ⅴ度缺損31例49指，Ⅵ度缺損17例23指進行瞭手指全形再造。保留4箇足趾的，（足母）甲瓣供區用2趾甲皮瓣脩複；保留5箇足趾的，（足母）甲瓣供區用皮瓣移位或移植來脩複，第2足趾關節供區取髂骨充填。手指Ⅳ度缺損和部分Ⅴ度缺損，採用（足母）趾腓揹側骨、趾甲、皮膚複閤組織瓣，串1條髂骨再串第2趾近側趾間關節的方法再造。部分近節指骨缺失長度較長的Ⅴ度缺損手指，採用（足母）趾腓揹側骨、趾甲、皮膚複閤組織瓣，串l條髂骨，再串第2趾近側趾間關節，最後還要在近節指骨殘耑與移植的第2趾近側趾間關節間再串l條髂骨的方法再造。Ⅵ度缺損的手指，採用以下順序串連：（足母）趾腓揹側骨、趾甲、皮膚複閤組織瓣，串l條髂骨，串第2趾近側趾間關節重建手指近指間關節，串l條髂骨重建近節指骨，串第2蹠趾關節重建掌指關節的方法再造。 結果 再造手指157指全部成活。平均隨訪7箇月～11年，其中75指行二期整形手術。再造手指外形美觀，再造指指腹兩點辨彆覺為5～12mm。67指行術後肌腱鬆解手術，再造指間關節活動度：伸-10°～10°，屈55°～ 100°，平均81°。結論 手指Ⅳ度至Ⅵ度缺損全形再造，再造的手指兼具美觀外形與良好運動功能，缺點是手術較複雜。
목적 개소수지Ⅳ～Ⅵ도결손적전형재조방법。 방법 자1998년12월지2010년12월，대수지Ⅳ도결손63례85지,Ⅴ도결손31례49지，Ⅵ도결손17례23지진행료수지전형재조。보류4개족지적，（족모）갑판공구용2지갑피판수복；보류5개족지적，（족모）갑판공구용피판이위혹이식래수복，제2족지관절공구취가골충전。수지Ⅳ도결손화부분Ⅴ도결손，채용（족모）지비배측골、지갑、피부복합조직판，천1조가골재천제2지근측지간관절적방법재조。부분근절지골결실장도교장적Ⅴ도결손수지，채용（족모）지비배측골、지갑、피부복합조직판，천l조가골，재천제2지근측지간관절，최후환요재근절지골잔단여이식적제2지근측지간관절간재천l조가골적방법재조。Ⅵ도결손적수지，채용이하순서천련：（족모）지비배측골、지갑、피부복합조직판，천l조가골，천제2지근측지간관절중건수지근지간관절，천l조가골중건근절지골，천제2척지관절중건장지관절적방법재조。 결과 재조수지157지전부성활。평균수방7개월～11년，기중75지행이기정형수술。재조수지외형미관，재조지지복량점변별각위5～12mm。67지행술후기건송해수술，재조지간관절활동도：신-10°～10°，굴55°～ 100°，평균81°。결론 수지Ⅳ도지Ⅵ도결손전형재조，재조적수지겸구미관외형여량호운동공능，결점시수술교복잡。
Objective To introduce the clinical application of full reconstruction for 72 cases of Ⅳ to Ⅵ-degree finger defect. Methods From December 1998 to December 2010, sixty-three cases (85 fingets) of Ⅳ-degree finger defect, thirty-three cases (49 fingers) of Ⅴ-degree finger defect and 17 cases (23fingers) with Ⅵ-degree finger defect were applied full reconstruction. The procedures of full reconstruction of Ⅳ to Ⅴ-degree finger defect were as follows: Harvest part of nail, skin which includes some skin harvested from dorsal and palmar metatarsal to ensure the length of the reconstructed finger, and dorsal part of distal phalanx from hallux to form a composite flap, which constitute the contour of a finger, and harvesting interphaalangeal joint from the second toes to reconstruct the proximal interphalangeal (PIP) joint. Bone transplantation from the iliac bone to the distal (for Ⅳ-degree and light Ⅴ-degree defect) or both proximal and distal (for severe Ⅴ-degree defect) stump of the reconstructed PIP joint was needed to get to an appropriate length.On the basis of the treatment of Ⅴ-degree defect, reconstruction of Ⅵ-degree finger defect was to harvest one more joint: the metatarsophalangeal joint of the second toe, and connect it with the proximal iliac bone rod.Results About half of the cases were conserved of 4 toes, and the donor wound of halluxes were covered with the composite flaps (composed of nail, skin) harvested from the second toes which had been sacrificed.The other cases were conserved of all the 5 toes, and the donor wound of halluxes were covered by free flap transplantation. The second toes were reconstituted by bone transplantation from the iliac bones. All of the 157 fingers survived completely, and 75 fingers underwent second-stage plastic surgeries. Sixty-seven fingers underwent second-stage tenolysis surgeries. Follow-ups 7 months to 11 years after surgery, and all the reconstructed fingers had realistic configurations, and the two-point discrimination of the finger pulps ranges from 5 mm to 12 mm. Dorsal extension of the PIP joints were -10°～10°, flexion of the PIP joints range from 55° to 85°, and the average was 76°. Conclusion The full reconstruction is an ideal alteration for Ⅳ to Ⅵ-degree finger defect reconstruction for the realistic configuration and ideal function of the reconstructed fingers.The one disadvantage of the full reconstruction is that the surgery is much more complex.
