目的 探讨对于指体发育不良的复拇畸形采用岛状推移皮瓣进行指体融合术的必要性和可行性.方法 2007年2月至2015年1月,对于存在指体发育不良的复拇畸形(指甲宽度和/或指体周径＜健侧80％),同时伴有2个指体均存在桡偏畸形或桡侧指体短于尺侧指体者,以桡侧指的指动脉神经为蒂,设计包括指甲、末节骨片和皮肤等在内的岛状复合组织瓣,组织瓣向前推移后,与切除部分桡侧面组织的尺侧指合并重建新的指体;对于仅表现为指体周径小的不全性发育不良者,仅设计岛状皮瓣进行指体的扩容.共26例29只手入组,术前常规进行复拇的彩色B超进行血管探测,观察复拇的拇主要动脉和指固有动脉的数量和走行.以我们制定的评价标准进行美学评价,以Tada评分评价重建指功能.结果 29只手通过术前彩色多普勒血流探测仪探测和手术探查,发现发育不良的复拇畸形血管分布有2种基本形式:Ⅰ型,主指和副指均只有1条指动脉和指神经,共24只手(82.76％);Ⅱ型,桡侧指为1条指动脉和神经,尺侧指为2条指动脉和神经,共5只手(17.24％).所有病例均按术前设计,在桡侧指顺利形成岛状复合组织瓣.23例26只手获得6个月以上随访,其中22只手皮瓣成活顺利;2只手出现张力性水泡,未经特殊处理自行消退;2只手出现远端干性坏死,未经特殊处理,创口自行愈合.25只手创口一期愈合,1只创口发生感染,经换药后愈合.功能评价:优21指(80.77％),良4指(15.38％),可1指(3.85％).指甲美学评价:优13指(72.22％),良4指(22.22％),可1指(5.56％).结论 所有病例的桡侧指均存在1条发育良好的指动脉,可以满足岛状复合组织瓣的血供需求;切取的组织瓣纵向推移可以获得必要的推进距离以消除2指不等长带来的张力.绝大部分发育不良的尺侧指同样只有1条血管神经系统,采用带有完整血管神经系统的轴型皮瓣或岛状皮瓣进行指体重建,不仅可以改变指体外观,而且使重建指获得2套血管神经系统.%Objective To investigate the necessity and feasibility of digit fusion with an advanced island flap in thumb dysplasia of radial polydactyly.Methods From February 2007 to January 2015,we collected the patients with radial polydactyly,whose nail width or thumb girth was less than 80％ of contralateral side.Among them,some patients were also associated with radial deviation deformities in two thumbs or a shorter radial thumb compared with ulnar thumb.In these cases,an island compound flap,which was based on proper palmar digital artery (PPDA) in radial thumb and contained nail,part distal phalanx and skin,combining with ulnar side of ulnar thumb was used to reconstruct a new thumb.Only the patients with a smaller thumb girth were treated by an island flap to augment the thumb size.There were 26 patients,including 29 sides.Preoperative Doppler ultrasonic examination was assigned to observe the amount and distribution of princepspollicisartery(PPA) and PPDA.Appearances were evaluated by Wang -Gao scoring system and functions were evaluated by Tata scoring system.Results There were two basic artery forms through preoperative ultrasonography and surgical exploration in 29 hands:both thumbs only had one PPDA;the main thumb had two while the extra thumb still had one.The former was responsible in 82.76％ (24 hands).All cases were operated according to preoperative design using an island compound flap.26 hands in 23 patients were followed up more than 6 months.Flap results included survival in 22 patients,tension vesicle in 2 patients and tip necrosis in 2 patients.The incision was infected in one patient with the treatment of changing dressing regularly.The function results were excellent in 21 patients,good in 4,fair in 1.Aesthetic results were excellent in 13 patients,good in 4 and fair in 1.Conclusions There is always one developed PDAA in extra thumb,which can be used to design a flap.The longitudinal advanced flap can also eliminate the tension caused by unequal length in two thumbs.Using an axial or island flap to reconstruct a new thumb can not only change the appearance,but also make the reconstructed thumb acquire two sets of blood supply and nerve system.
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