足趾复合组织联合皮瓣重建拇指缺损

摘要

目的 介绍(姆)甲皮瓣联合第二趾骨及跖趾关节、肌腱(足趾复合组织)再造拇指及皮瓣修复虎口的效果.方法 2006年3月至2010年5月,对5例外伤性拇指Ⅴ度以上缺损,采用足趾复合组织再造拇指,并用游离或带蒂岛状皮瓣修复虎口.结果 5例中1例失访,4例获得随访时间为12～ 60个月.根据中华医学会手外科学会拇、手指再造功能评定试用标准进行评定:优1例,良2例,可1例；再造拇指和虎口外形及功能满意.供足行走正常,无疼痛等后遗症.结论 足趾复合组织及皮瓣联合再造外伤性拇指Ⅴ度以上缺损可获得较好的临床效果,对外形要求较高的年轻患者比较适用.%Objective To explore the effectiveness of reconstructing thumb by big toe wrap-around flap combined with metatarsophalangeal joint and tendon transfer from the second toe and flrst web reconstruction by flaps.Methods Five cases of type Ⅴ thumb defect were treated from March 2006 to May 2010 by composite toe transfer to reconstruct the thumb and by a free or pedicled flap to reconstruct the flrst web.Postoperative results were evaluated using the criteria for function of reconstructed thumb and fingers issued by the Hand Surgery Society of the Chinese Medical Association.Results Four cases were follow-up for 12 to 60 months.The results were graded as excellent in 1 case,good in 2 cases and fair in 1 case.Function and form of the reconstructed thumb and first web were satisfactory.The donor foot maintained normal gait.There were no complications and pain.Conclusion Composite toe transfer combined with flap transfer can achieve good clinical outcomes in reconstruction of type Ⅴ thumb defects.It is indicated for young patients who have high expectation on appearance of the thumb.