再造拇指甲床扩大术的两种手术方法及比较

摘要

Objective To compare the clinical outcomes of two kinds of nail bed expanding technique for the new aesthetic modifies in second toe-to-thumb transfer surgery. Methods 18 cases suffered from finger defected were treated by second toe-to-thumb transfer surgery. They were divided into two groups; According to the preoperative anatomical measurement data, we calculated the ratio of the length of second distal toe and its nails, the ratio of the length of distal thumb and its nails. After calculation, we measured the absolute value of the toenail extension. During the operation, the eponychium was resected for the first 9 cases and the Adani rectangular advanced flap was performed in the second 9 cases. The expanded nails were the same length. The operative times for only nail lengthening were recorded and the length of the nail, appearances, the scarring around the nail and patients self satisfaction comparison evaluation in two groups were compared in 16 months postoperatively. Results The operation time of eponychium resection was an average of 7 minutes; the time of the Adani rectangular advanced flap average of 13 minutes;16 months postoperative follow-up, no skin necrosis around the nail in both groups cases; a bed expand length for the duration of 2.8 mm in both groups; the smoothness of the nail was consistent, without obvious deformity happened. The self satisfaction score (MHQ) of eponychium resection group was average of 12.4; the score of the Adani rectangular advanced flap was average of 11.9. The differences between the two groups were no statistically significant. Conclusion Both of the two kinds of nail lengthening in second toe-to-hand transfer surgery are simply and effective; the results are satisfactory; the procedure of eponychium resection is of advantages of short operative time and easy to handle.%目的：报道应用第2足趾再造拇指甲床扩大术的两种方法及临床对照分析。方法对因外伤引起的手指缺损行第2足趾再造拇指术的18例患者分为两组。根据术前解剖学测量数据，计算第2足趾甲长与末节趾长的比值，与健侧拇指甲长与末节指长的比值，经过测算，算出趾甲延长的绝对值。分别采用Adani矩形推进皮瓣术和部分甲皱襞直接切除术，均扩大指甲长度，使再造拇指甲长与末节指长的比值达到健侧拇指甲长与末节指长的比值。于术中记录两组甲延长术手术时间；术后16个月时，观察指甲扩大情况，甲光滑度，甲周瘢痕形成情况及患者自我满意度，两组进行对照评估。结果第一组Adani矩形推进皮瓣术组手术时间平均13 min；第二组部分甲皱襞直接切除术手术时间平均7 min；术后16个月时随访两组病例甲周皮肤均无坏死，甲床扩大长度两组均为均数2.8 mm，甲光滑度一致，无明显甲畸形发生。甲周均无不稳定瘢痕形成；Adani矩形推进皮瓣术组患者自我满意度评分（MHQ）均数达11.9分，部分甲皱襞直接切除术组为12.4分，两组对照差异无显著性。结论根据术前个体化解剖测量值，足趾再造拇指甲床扩大术的两种方法均手术简单，效果满意，甲皱襞直接切除法具有手术时间短、操作简便的优势。