CAJ | 학술논문

目的介绍手指Ⅰ至Ⅲ度缺损全形再造的方法。方法从1998年12月至2010年12月，对手指Ⅰ度和Ⅱ度缺损，根据受区需要设计切取（足母）趾腓侧部分趾甲、趾甲下趾骨的腓背侧部分以及皮肤，形成趾甲、骨、皮肤复合组织瓣。皮瓣卷成圆筒状包裹趾骨形成新的手指远段，像断指再植一样，将再造的手指远段移植到手指残端形成新的手指。对于手指Ⅲ度缺损，皮肤仍根据残指需要的大小在（足母）趾上设计，但趾骨因只能在（足母）长伸肌腱止点以远切取，且只切取腓背侧部分，长度有限，有些病例不能达到原缺损的长度时，则取适当大小形状的髂骨与取下的趾骨串在一起，移植到手指残端再造出新的手指。部分手指Ⅲ度缺损病例，同时切取第2足趾趾间关节移植再造手指远侧指间关节。第2足趾骨缺损用髂骨充填以保持第2趾的外形。（足母）趾创面采用局部皮瓣移位修复或游离皮瓣移植修复。结果 Ⅰ度缺损118例126指，Ⅱ度缺损187例201指，Ⅲ度缺损90例111指全部成活，外形接近正常手指。其中150指进行了1～5年的随访，手指总活动度全部达到180°以上。趾间关节移植再造远指间关节的病例术后再造手指远指间关节活动度为15°～40°。供区（足母）趾术后长度与周径接近正常，虽然趾甲大部分缺失，但供足行走功能全部正常。结论（足母）趾腓背侧复合组织瓣移植或（足母）趾腓背侧复合组织瓣加髂骨串联移植再造手指Ⅰ至Ⅲ度缺损，再造手指功能外形俱佳，供区皮瓣修复后（足母）趾形状与功能所受影响小。
목적 개소수지Ⅰ지Ⅲ도결손전형재조적방법。 방법 종1998년12월지2010년12월，대수지Ⅰ도화Ⅱ도결손，근거수구수요설계절취（족모）지비측부분지갑、지갑하지골적비배측부분이급피부，형성지갑、골、피부복합조직판。피판권성원통상포과지골형성신적수지원단，상단지재식일양，장재조적수지원단이식도수지잔단형성신적수지。대우수지Ⅲ도결손，피부잉근거잔지수요적대소재（족모）지상설계，단지골인지능재（족모）장신기건지점이원절취，차지절취비배측부분，장도유한，유사병례불능체도원결손적장도시，칙취괄당대소형상적가골여취하적지골천재일기，이식도수지잔단재조출신적수지。부분수지Ⅲ도결손병례，동시절취제2족지지간관절이식재조수지원측지간관절。제2족지골결손용가골충전이보지제2지적외형。（족모）지창면채용국부피판이위수복혹유리피판이식수복。 결과 Ⅰ도결손118례126지，Ⅱ도결손187례201지，Ⅲ도결손90례111지전부성활，외형접근정상수지。기중150지진행료1～5년적수방，수지총활동도전부체도180°이상。지간관절이식재조원지간관절적병례술후재조수지원지간관절활동도위15°～40°。공구（족모）지술후장도여주경접근정상，수연지갑대부분결실，단공족행주공능전부정상。 결론 （족모）지비배측복합조직판이식혹（족모）지비배측복합조직판가가골천련이식재조수지Ⅰ지Ⅲ도결손，재조수지공능외형구가，공구피판수복후（족모）지형상여공능소수영향소。
Objective To introduce the new method of full reconstruction for Ⅰ to Ⅲ-degree finger defect. Methods For reconstruction of Ⅰ to Ⅱ-degree finger defect, the surgery procedure was as follows:Harvest part of nail, skin and dorsal part of distal phalanx from hallux to form a composite flap, and then the flap was transplanted to the finger stump to reconstruct the defect part of the finger. The design of the composite flap was according to the recipient part. For reconstruction of Ⅲ-degree finger defect, the skin included in the flap could be designed according to the recipient part, but the bone can only be harvested from the fibulodoral part of the hallux and far from the insertion of the extensor hallucis longus tendon, which means the length was limited. If the bone length was not enough, one bone mass with appropriate size and shape was harvested from the iliac bone and connected with the bone of the composite flap. Some cases of Ⅲ-degree finger defect were reconstructed by harvesting interphalangeal joints from the second toes to reconstruct distal interphalangeal joints(DIP). The bone defect was reconstituted by bone mass from the iliac bone to conserve the contour of the second toe. The hallux wound was covered by a local flap or free flap transplantation.Results One hundred and eighteen cases (126 fingers) of Ⅰ-degree defect, one hundred and eighty-seven cases (201 fingers) of Ⅱ-degree defect and 90 cases (111 fingers) of Ⅲ-degree finger defect were applied full reconstruction. All the reconstructed fingers survived completely and the configurations were similar to real fingers. Followed up our work on 150 fingers from a number of patients, between 1 and 11 years after the original surgery. Total ranges of motion of the reconstructed fingers got to over 180°. The reconstructed DIP joints had the range of motion of 15°-40°. The donor halluxes and toes were conserved with the normal length,relatively primary appearance and full function. Conclusion Full reconstruction for Ⅰ to Ⅲ-degree finger defect has great advantages in that the reconstructed finger has very realistic configuration as well as ideal function and the donor hallux is conserve well.