CAJ | 학술논문

目的总结采用第二足趾节段桥接移植修复手指指骨中间节段复合组织缺损的方法和疗效.方法 2007年6月至2011年8月,对8例拇手指近或中节指骨中间节段复合组织缺损,采用第二足趾节段复合组织桥接移植修复.其中拇指3例,示指2例,中指2例,环指1例；采用带第二足趾近趾间关节节段复合组织4例,不含关节的节段复合组织4例.足部供区均采用截趾术.结果术中1例足趾在游离过程中发生血管痉挛,经局部对症处理后解除；术后8例复合组织及再植拇、手指均顺利存活,供、受区伤口均Ⅰ期愈合.随访6～24个月,平均12个月,修复指体外形良好,恢复了屈、伸及抓捏功能.供足留有线条瘢痕,行走功能无影响.按中华医学会手外科学会断指再植评定标准评定:优2例,良5例,可1例；优良率为87.5％.结论采用第二足趾节段复合组织桥接移植修复手指中间节段组织缺损,虽然手术难度及风险较大,但修复后手指外形逼真,功能良好,是值得推广的一种术式.
목적 총결채용제이족지절단교접이식수복수지지골중간절단복합조직결손적방법화료효.방법 2007년6월지2011년8월,대8례무수지근혹중절지골중간절단복합조직결손,채용제이족지절단복합조직교접이식수복.기중무지3례,시지2례,중지2례,배지1례；채용대제이족지근지간관절절단복합조직4례,불함관절적절단복합조직4례.족부공구균채용절지술.결과 술중1례족지재유리과정중발생혈관경련,경국부대증처리후해제；술후8례복합조직급재식무、수지균순리존활,공、수구상구균Ⅰ기유합.수방6～24개월,평균12개월,수복지체외형량호,회복료굴、신급조날공능.공족류유선조반흔,행주공능무영향.안중화의학회수외과학회단지재식평정표준평정:우2례,량5례,가1례；우량솔위87.5％.결론 채용제이족지절단복합조직교접이식수복수지중간절단조직결손,수연수술난도급풍험교대,단수복후수지외형핍진,공능량호,시치득추엄적일충술식.
Objective To explore the surgical method and clinical effect of repairing composite tissue defects of the digit by transplanting a segment of the second toe.Methods Between June 2007 and August 2011,8 cases of composite tissue defect of the digits including 3 cases of thumb defect,2 cases of index finger defect,2 cases of middle finger defect and 1 case of ring finger defect were treated in our hospital by transplanting a segmem of the second toe.Transfer of a segment of the second toe containing the proximal interphalangeal joint was done in 4 cases,while the other 4 cases received a second toe segment without the interphalangeal joint.The donor sites were closed by amputating the remaining of the second toe in all the cases.Results Vasospasm occurred in one case during the operation and was relieved by local application of papaverine.All the transplants and reconstructed fingers and thumbs survived.The wounds at both recipient and donor sites healed primarily.The patients were follow-up for 6 to 24 months (mean,12 months).All repaired digits presented satisfactory appearance and recovered the function of flexion,extension,grip and pinch.The donor sites only had linear scars and no functional impairment was observed.According to the assessment criteria of replantation of anputated finger formulated by the Chinese Medical Association,the results were excellent in 2 cases,good in 5cases and moderate in 1 case with the excellent and good rate of 87.5 ％.Conclusion Although utilizing a segment of the second toe to repair composite tissue defects of the digits has some degree of difficulty and risk,the recorstructed fingers have good appearance and function.This surgical method deserves general application.