CAJ | 학술논문

目的探讨顺行推进皮瓣结合克氏针矫形治疗拇指外伤术后钩甲畸形疼痛的手术方法及临床效果.方法自2013年6月至2014年6月,采用拇指尺侧带一侧血管神经束顺行推进皮瓣及克氏针矫形修复拇指外伤术后钩甲畸形疼痛患者9例,男7例,女2例;年龄12 ～ 58岁.外伤术后直接缝合导致钩甲畸形6例,外伤采用简单V-Y推进皮瓣术后导致钩甲畸形3例.术中拇指指端采用鱼嘴状切口指甲拔除,3枚直径0.8mm克氏针插入末节指骨支撑矫形甲床,指端残留创面面积为1.2 cm×0.8 cm～ 1.2 cm× 1.2 cm,均采用尺侧带血管神经束顺行推进皮瓣修复,供区直接缝合或者前臂内侧取皮植皮术.结果术后9例均获得随访,供区创面Ⅰ期愈合.随访12～15个月,所有患者包括儿童均能很好地耐受手术及术后处理,未见明显并发症;对指端、指甲外形及功能的改善均很满意.推进皮瓣质地柔软,有指纹,静止两点分辨觉4～6mm.指甲完全生长的时间为6～8个月,1例患者术后仍然残留轻微钩甲但指端无疼痛,其余未见钩甲畸形,指端无疼痛麻木.结论采用顺行推进皮瓣结合克氏针矫形是一种治疗拇指外伤术后钩甲畸形疼痛比较理想的手术方法.
목적 탐토순행추진피판결합극씨침교형치료무지외상술후구갑기형동통적수술방법급림상효과.방법 자2013년6월지2014년6월,채용무지척측대일측혈관신경속순행추진피판급극씨침교형수복무지외상술후구갑기형동통환자9례,남7례,녀2례;년령12 ～ 58세.외상술후직접봉합도치구갑기형6례,외상채용간단V-Y추진피판술후도치구갑기형3례.술중무지지단채용어취상절구지갑발제,3매직경0.8mm극씨침삽입말절지골지탱교형갑상,지단잔류창면면적위1.2 cm×0.8 cm～ 1.2 cm× 1.2 cm,균채용척측대혈관신경속순행추진피판수복,공구직접봉합혹자전비내측취피식피술.결과 술후9례균획득수방,공구창면Ⅰ기유합.수방12～15개월,소유환자포괄인동균능흔호지내수수술급술후처리,미견명현병발증;대지단、지갑외형급공능적개선균흔만의.추진피판질지유연,유지문,정지량점분변각4～6mm.지갑완전생장적시간위6～8개월,1례환자술후잉연잔류경미구갑단지단무동통,기여미견구갑기형,지단무동통마목.결론 채용순행추진피판결합극씨침교형시일충치료무지외상술후구갑기형동통비교이상적수술방법.
Objective To introduce the surgical techniques and investigate the clinical outcomes of using anterograde advancement flap combined with Kirschner wire correction for treatment of post-traumatic hook nail deformity of the thumb.Methods From June 2013 to June 2014, 9 cases of post-traumatic hook nail deformity of the thumb were treated with anterograde advancement flap combined with Kirschner wire correction.There were 7 males and 2 females with ages ranged from 12 to 58 years.The hook nail deformity occurred after direct suturing of the thumb tip wound in 6 cases and after V-Y advancement flap surgery in 3 cases.Intraoperatively the deformed fingernail was removed via a fish mouth incision.Three 0.8 mm Kirschner wires were inserted into the distal phalanx to support the nail bed.The size of fingertip defects ranged from 1.2 cm × 0.8 cm to 1.2 cm × 1.2 cm.The defects were repaired with the anterograde advancement flap based on the ulnar neurovascular bundle.The donor site was directly closed or covered with skin graft from medial forearm.Results Incisions of all 9 cases healed by first intention.The patients were follow-up for 12 to 15 months.All patients, including pediatric patients, tolerated the surgery and postoperative treatment well.There were no significant complications.All the patients were satisfied with the improvements in fingernail appearance and function.The texture of the flap was soft with retained fingerprint.Static two-point discrimination was 4 to 6 mm.It took 6 to 8 months for complete nail growth.All but one finger had no residual hook nail deformity and no tenderness and numbness.The nail of one patient remained slightly deformed but without pain and functional disturbance.Conclusion Anterograde advancement flap combined with Kirschner wire correction is an ideal method for treatment of post-traumatic hook nail deformity of the thumb.