Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

应用改良(躅)甲瓣修复拇手指脱套伤

目的 探讨应用改良(躅)甲瓣修复各型拇、手指脱套伤的临床疗效.方法 根据不同损伤类型,采取4种方式修复18例28个脱套拇手指:①单侧改良(躅)甲瓣修复9例9个拇指近节中段以远脱套及3例3指近侧指间关节以远脱套;②单侧改良(躅)甲瓣加第二趾胫侧皮瓣修复2例2指全指脱套;③双侧改良(躅)甲瓣修复1例双侧拇指脱套;④双侧改良(躅)甲瓣加第二趾胫侧皮瓣与带感觉的超薄股前外侧皮瓣修复3例12指脱套.(躅)甲瓣切取时携带全部趾甲,保留(躅)趾趾底偏胫侧三角形皮瓣.结果 18例22块(躅)甲瓣及3块超薄股前外侧皮瓣均一期完全成活.15例获随访8～25个月,再造拇、手指外观接近健侧指体,运动及感觉恢复满意,供区无增生性瘢痕,跖底三角形皮瓣显著增宽,所有患者步行、跑、跳均无明显受限.结论 应用改良(躅)甲瓣修复拇手指脱套伤,不但受区可以获得接近健侧的良好外观和功能,而且可使供区损伤减少到最低限度,是目前显微重建拇、手指脱套伤的最佳术式之一.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

Reconstruction of degloved thumb with prefabricated flap

The wrap around the toe flap from the great toe is considered to be a good reconstructive proce-dure for degloved injuries of the thumb. 1 In this study, we used prefabricated flaps of the medial plan-tar skin to cover a degloved injury of the thumb of a patient unsuitable for application of this method and obtained satisfactory clinical results.     

示指背侧皮瓣与趾腓侧皮瓣瓦合修复拇指套脱伤

目的 介绍应用示指背侧岛状皮瓣与游离趾腓侧皮瓣瓦合修复拇指套脱伤的临床方法.方法 对9例残留甲床的拇指套脱伤患者,采用示指背侧岛状皮瓣与趾腓侧游离皮瓣瓦合进行修复.结果 术后9例拇指瓦合皮瓣全部存活,随访时间为6个月至3年,皮瓣颜色、质地良好,拇指指甲生长良好,外形和功能满意,皮瓣两点分辨觉为8～10mm.供区示指及足趾植皮区愈合良好,无明显功能影响.结论 示指背侧岛状皮瓣与游离趾腓侧皮瓣瓦合修复是治疗残留甲床的拇指套脱伤的一种较好方法.     

背甲皮瓣移植联合带指神经血管蒂岛状皮瓣移位再造拇指

目的探索拇指再造的新术式。方法采用吻合血管的背甲皮瓣移植联合带指神经血管蒂的岛状皮瓣移位,急诊延迟再造拇指。根据拇指残端情况,可选用中指尺侧或环指桡侧的岛状皮瓣。结果再造拇指３例全部成活,外形与功能恢复均良好。结论为急诊延迟再造拇指提供一种新方法,适用于拇指皮肤脱套伤及Ⅱ、Ⅲ度截指。     

不同形式的第二趾甲皮瓣移植修复不同程度的手指皮肤脱套伤

目的总结第二趾甲皮瓣的临床应用效果并探索手指皮肤脱套伤最合理的治疗方案。方法根据手指皮肤脱套伤的特点,将83例95指手指皮肤脱套伤分为二度。Ⅰ度脱套伤:2～5指皮肤脱套范围自指中节中段至指尖,采用单纯第二趾甲皮瓣修复,共59指。Ⅱ度脱套伤:2～5指皮肤脱套范围自指根部至指尖,采用带足背皮瓣的第二趾甲皮瓣修复,共36指。结果95块甲皮瓣全部存活。术后65指随访8个月～5年10个月,失访30指。按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,优62指、良3指。结论第二趾甲皮瓣是治疗手指皮肤脱套伤最合理的方法之一。对手指皮肤脱套伤的伤情进行分度,有利于治疗方案的选择。     

前臂及拇背侧皮神经营养血管蒂岛状皮瓣的临床应用

目的探讨前臂及拇背侧带皮神经营养血管蒂岛状皮瓣临床应用的适应证。方法利用以前臂外侧皮神经营养血管为蒂的岛状皮瓣修复拇指末节脱套伤2例,带拇背桡侧皮神经营养血管蒂岛状皮瓣及尺背侧皮神经营养血管蒂逆行岛状皮瓣修复拇指掌侧软组织缺损10例。皮瓣切取面积2cm×3cm～7cm×11cm。结果11例皮瓣全部成活,1例前臂外侧皮神经皮瓣因切取面积较大导致远端部分坏死。结论以前臂皮神经营养血管为蒂的岛状皮瓣适用于拇指末节脱套伤,但皮瓣长度不应超过11cm;拇背侧皮瓣宽度较小,仅适宜修复拇指较小面积的软组织缺损。     

拇指脱套状撕脱性离断再植58例临床分析

目的探讨拇指脱套状撕脱性离断再植的方法及术后血管危象的处理，以提高再植的成功率。方法对58例脱套状撕脱性离断拇指进行再植，积极处理术后血管危象。结果再植58例成活54例，成活率93．1％。随访40例，平均随访12个月，优21例，良16例，中3例，优良率92．5％。结论拇指脱套状撕脱性离断损伤严重，手术难度大，要求高，但经过术前、术中的周密安排，术后积极地防治血管危象后，其成活率可得到相应提高。     

第一、二趾全背侧皮甲瓣互换的第二趾Ⅰ期塑形再造拇指

目的 探讨改进第2趾游离移植再造拇指外形的方法.方法 在切取第2趾之前,先切取其近端带蒂的全背侧皮甲瓣并留于足部.然后在游离第2趾时一同游离(足母)趾全背侧皮甲瓣,将趾全皮甲瓣与无背侧皮甲瓣的第2趾组装成为外形更近似拇指的组合足趾再造拇指.将第2趾全背侧皮甲瓣覆盖(足母)趾背侧创面,修复供区.结果 手术12例(12指)全部成活,其中8例得到6～9个月随访,再造拇指外观逼真(特别是背侧),其粗细、长度接近正常,外形及功能良好,优7例,良1例.(足母)趾的外观及功能无明显影响,行走感觉不适、有轻微疼痛者1例,但不影响行走及工作.结论 应用此方法对供区破坏较小,设计合理,患者易接受,再造的拇指背侧外观无明显差异,是一种较理想的拇指再造方法.     

A new method of thumb reconstruction using big and second toe elements]

The author's modification of thumb reconstruction using the big and second toe elements is presented. Two separate parts were raised on one common pedicle to form future thumb. The main element including bones, tendons and soft tissues were taken from the second toe. The flap comprising nail radix, matrix and lateral fragment of the second toe pulp was prepared and left in situ. Similar flap was raised on the hallux. Winding of the hallux flap round the second toe part allowed to form nearly normal thumb. The nail radix and matrix were harvested subperiosteally without any bone fragments of distal phalanges. Harvesting of minimum of tissues from the hallux and covering the wound by similar flap from the second toe markedly limited the big toe deformation, typical for this type of procedure. The nail plate of the second toe looked acceptable on the slightly thinner hallux. Scares were localized out of the weight bearing surfaces. Best indications for this procedure include cases when the thumb is amputated on the proximal phalanx level. Rare anatomical variation of the toe vascularity may restrict application of this method. Individual length differences between the hallux and the second toe sometimes make it difficult to put the hallux flap in the proper position on the thumb. A small hallux valgity may appear when the second toe is too short.     

第2趾甲皮瓣及足背皮瓣修复全指脱套伤

目的探讨第2趾甲皮瓣及足背皮瓣修复全指皮肤脱套伤的临床效果。方法对23例26指（食、中指）全指皮肤脱套伤,采用第2趾甲皮瓣及足背皮瓣进行修复,皮瓣切取面积最大11．5cm×12．0cm,最小8．0cm×10．0cm。结果术后皮瓣全部成活,随访10-24个月,平均12．4个月,伤指外形及屈伸功能均满意,两点辨别觉为5-8mm。结论采用第2趾甲皮瓣及足背皮瓣修复全指皮肤脱套伤,可最大限度地恢复伤指的外形和功能。     

足趾移植拇指与手指再造的临床研究

目的探讨足趾移植拇指与手指再造的方法和疗效。方法采用部分坶趾移植拇指部分再造22例,躅甲瓣或带足背皮瓣船甲瓣移植拇指再造13例,第2足趾移植再造拇指4例,再造手指3例,及带足背皮瓣的第2足趾移植再造拇指7例,带足背皮瓣的第2,3足趾移植再造手指7例,带足背皮瓣的躅甲瓣或第2趾和第2,3趾组合移植再造拇手指10例,双足第2足趾移植全手缺失二指再造2例,共68例97指。结果再造拇手指和皮瓣全部成活,成活率为100％,术后经3月～10年的随访和信访,按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：优62指,良24指,可9指,差2指,优良率达88．66％。结论采用部棚趾、第2足趾棚甲瓣移植再造拇手指,带足背皮瓣的躅甲瓣、第2趾或第2,3趾组合移植行合并手部皮肤缺损的拇手指再造,效果满意。     

Free second toe one-stage-plasty and transfer for thumb or finger reconstruction

Free second toe transfer has become a popular method for the management of thumb or finger reconstruction. However, this creates an obvious appearance defect. A new operating procedure has been used since 1999. To enlarge the perimeter of the reconstructed thumb, a composite tissue strip flap from the fibular of great toe pedicled with the fibular proper plantar digital artery, combined or not with the island dorsal index finger flap, was inlaid with the second toe at the same time before the reconstruction. A crescent double-winged dorsal metatarsus flap, connected with second toe, in combination with the partial metatarsal bone, was also used to reconstruct fingers. There were 36 patients in the study group with a follow-up time of 6 months to 3 years. The thumb and finger reconstructed in this way showed better appearance, with normal caliber and length and without obvious adverse affects. This method has ameliorated the embarrassing appearance of the reconstructed thumb with earlier methods and is a relatively ideal method for thumb or finger reconstruction.