摘要
目的报告游离（母）甲皮瓣与对侧第二趾胫侧皮瓣瓦合修复拇指末节皮肤套脱伤的方法和疗效。方法对8例拇指末节皮肤套脱伤，选用游离同侧躅甲皮瓣，对侧第二趾胫侧皮瓣瓦合修复。对跨甲皮瓣供区的处理，2例采用同侧第二趾侧方皮瓣覆盖，第二趾供区全厚皮片植皮，6例采用全厚皮片植皮。对侧第二趾供区均采用全厚皮片植皮。结果术后8例移植瓦合皮瓣全部存活，伤口均Ⅰ期愈合，足部供区植皮均顺利成活。术后随访5—18个月，平均8个月，皮瓣颜色与正常手指相同，皮瓣元明显萎缩及色素沉着，拇指外形满意，指甲生长良好，指腹感觉恢复是S2-S3＋，指间关节伸、屈活动良好。供区植皮无瘢痕挛缩，无破溃，足趾无垂趾畸形，足部活动无影响。结论应用游离（母）甲皮瓣与对侧第二趾胫侧皮瓣瓦合修复拇指末节皮肤套脱伤，不牺牲末节蹲趾，可以获得较好的外形和功能。
Objective To report the operation methods and clinical effects of combined wrap-around flap of the big toe and tibial flap of the opposite second toe in treating degloving injuries of the thumb. Melhods Eight cases of thumb degloving injuries were treated with free wrap-around flap from the ipsilateral big toe and tibial lateral-flap from the opposite second toe. In 2 cases, the donor site of the big toe was covered by flap transfer from the side of the adjacent second toe, while the resulting second toe skin defect was covered by full thickness skin graft. In 6 cases full thickness skin graft was used to cover the big toe donor site defects. All donor site defects on the opposite second toe were covered with full thickness skin graft. Results All 8 combined flaps survived. The wound healed primarily. Skin grafts in the donor sites of the foot also survived. Postoperative follow-up ranged from 5 to 18 months, with an average of 8 months. The flap color was the same as normal finger flap without obvious atrophy and pigmentation. The appearance of the thumb was satisfying. Thumb nail grew well. Sensory recovery from S2 to S3 ＋ was achieved in the thumb pulp. Thumb interphalangeal joint tlexion and extension were good. The donor site skin graft had no scar contracture and no ulceration. There were no malformation of toe drop and no impairment of foot function. Conclusion Using combined wrap-around flap of the big toe and tibial flap of the opposite second toe in treating degloving injuries of the thumb could achieved good appearance and function without sacrificing distal segment of the big toe.
出处
《中华手外科杂志》
CSCD
北大核心
2013年第1期34-36,共3页
Chinese Journal of Hand Surgery
关键词
外科皮瓣
移植
显微外科手术
套脱伤
Surgical flaps
Transplantation
Microsurgery
Degloving injuries
