自体趾尖部分移植再造手指指尖

目的 探讨自体(砪)趾尖部分移植再造手指指尖的手术方法.方法 2002年8月-2008年1月,以自体(砪)趾尖为供体,于其腓侧设计与缺损的手指指尖大小相同的部分趾尖,游离切取塑形后移植再造手指指尖.再造手指指尖32例32指,其中拇指指尖11例,示指指尖13例,中指指尖8例.急诊再造11例,择期再造21例.供区创面直接缝合.结果 本组32例全部存活,其中1例右示指指尖再造术后14 h出现静脉危象,手术探查后存活.27例于术后3～8个月内行整形术.随访29例,失访3例,随访时间为8～26个月,再造指尖外形接近健侧指尖,手指功能及两点分辨觉同健指.结论 自体(砪)趾尖部分移植再造手指指尖外形逼真,功能完善;供区无需植皮,供趾趾尖结构、外形、功能无改变,仅体积缩小.

Autologous toe tip transfer to reconstruct finger tip

Objective To explore the surgical techniques and indications of finger tip reconstruction by partial transfer of the big toe tip. Methods From August 2(D2 to January 2008, the following technique was applied in 32 cases of 32 fingers. Autologous big toe was used as donor. According to the size of the defect at the finger tip, a portion at the fibular side of the big toe with the same size was designed for harvesting. It was transferred to reconstruct the finger tip after remodelling. There were 11 cases of thumb tip defect, 13 cases of index finger tip defect and 8 cases of middle finger defect. Emergency reconstrution was performed in 11 cases,while the rest 21 cases were reconstructed with selective operations. The wound of the donor big toe was closed directly. Results The 32 reconstructed finger tips all survived. Venous crisis eceurred in one case of index fingertip reconstruction which resolved after surgical exploration. Twenty-seven cases underwent plnsty 3 to 8months after the first reconstruction. Twenty-nine cases were followed up for 8 to 26 months, while 3 cases were lost for follow up. The shape of the reconstructed finger is similar to that of the normal finger. The function and two-point discrimination was comparable to normal fingers. Conclusion Reconstruction of the finger tip with part of the autologous big toe leads to satisfactory appearance and perfect function. There is no need for skin graft to cover the donor site. The structure, appearance and function of the donor toe is not changed. The only disadvantage is that the volume of the donor ton is reduced.