前踝上皮瓣串联第2足趾移植再造拇指并修复虎口软组织缺损

摘要

目的 探讨应用前踝上皮瓣串联第2足趾移植再造拇指并修复虎口软组织缺损或重建虎口的临床疗效.方法 2008年6月至2016年1月,采用前踝上皮瓣串联第2足趾移植同期再造拇指伴虎口软组织缺损13例,男9例,女4例,年龄18～52岁,平均25岁.其中拇指Ⅲ度缺损伴手部软组织缺损3例,拇指Ⅳ度缺损伴手部软组织缺损6例,拇指Ⅴ度缺损创面已闭合3例,拇指Ⅴ度缺损伴软组织缺损1例.伴患手其他手指损伤者5例,鱼际均有不同程度损伤.术前有创面者10例,软组织缺损面积为3 cm ×5 cm～6 cm×13 cm,创面闭合者3例.术后定期分别对再造拇指的外形、感觉、功能、日常生活及工作情况,以及供区外观、功能情况进行随访.结果 本组13例再造拇指及前踝上皮瓣均成活,切口Ⅰ期愈合.术后随访2.5～10.0年,平均5.5年,再造拇指外形满意,恢复了温度觉、痛觉及触觉,两点辨别觉达到8～18 mm,拇指恢复了屈伸、对掌及对指功能,能够满足日常生活及工作需要.供区外观满意,无跛行,步行无疼痛,无功能障碍,小腿植皮区成活良好,无溃疡.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评定结果优10例,良2例,可1例.结论 应用前踝上皮瓣串联第2足趾移植一期再造拇指并修复虎口软组织缺损或重建虎口,是治疗拇指缺损伴软组织缺损的一种行之有效的方法.%Objective To explore the clinical efficacy of anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair or first web reconstruction.Methods A total of 13 cases were underwent anterior superior malleolus flap and second toe transplantation for thumb reconstruction and soft tissue defect repair from June,2008 to January,2016.There were 9 males and 4 females.The average age was 25 years old,ranging from 18 to 52.There were 3 cases of Ⅲ-degree thumb defect with soft tissue defect of hand,6 cases of Ⅳ-degree thumb defect with soft tissue defect of hand,3 cases of single Ⅴ-degree thumb defect and 1 Ⅴ-degree thumb defect with soft tissue defect.There were 5 patients accompanied with injury of other fingers of the affected hand.And the thenar muscles were also damaged to a varied degree.There were 10 patients with soft tissue defect before surgery,with the wound surface ranging from 3 cm × 5 cm-6 cm × 13 cm.And the wound of other 3 cases was closed.After the surgery,follow-up visit was conducted on the appearance,sensation,function,daily life and working condition of reconstructed thumb,the appearance and function condition of donor site.Results The reconstructed thumbs and anterior superior malleolus flaps in 13 cases survived and healed primarily.The average post-operative followed-up time was 5.5 years,ranging from 2.5 to 10.0 years.The appearance of reconstructed thumb was satisfactory,and the temperature sensation,pain sensation and touch sensation were recovered.The two-points discrimination was 8-18 mm.Moreover,the flexion and extension function,opposing function and finger-to-thumb function was recovered,which could meet the demand of daily life and work.The appearance of donor site was satisfactory,without claudication,pain or dysfunction.The survival of transplanted skin area in the calf was good,with no ulcer noticed.According to the Trial Standard for Thumb and Finger Reconstitution Functional Assessment of Hand Surgery Society of Chinese Medical Association,there were 10 cases excellent results,2 good and 1 fair.Conclusion Application of anterior superior malleolus flap and second toe transplantation for first-stage thumb reconstruction and soft tissue defect repair or thenar muscles and first web reconstruction is an effective therapeutic approach.