拇手指末节缺损的再造

目的 报道应用部分足趾组织移植进行指-趾动脉吻合的拇指、手指末节缺损再造的临床效果. 方法 拇指、手指末节及指尖缺损126例141指,包括拇指79指,示指37指,中指19指,环指6指.其中15例为2指同时再造.拇指再造病例中,应用部分躅趾组织移植者34指,部分第二足趾组织移植者45指:手指再造应用部分第二足趾组织移植者45指,部分第三足趾组织移植14指,部分第四足趾组织移植3指. 结果 术后发生动脉危象16指、静脉危象9指,经手术和药物治疗全部成活.31例行二期整形.87例94指得到随访,随访时间为6个月～15年.患者对再造指外形感到满意,能作指腹捏夹动作,感觉恢复到S3+以上者94指,其中76指的两点辨别觉达到6-8mm.供区无手术并发症. 结论 应用部分足趾组织移植进行指-趾动脉吻合的拇指、手指末节及指尖再造手术,术后的拇指、手指功能与外形比较符合患者的期望.

Reconstruction of end section defect of thumb and finger

Objective To describe the method and review the outcome of reconstruction of digital segment defect of thumb and finger by partial transplantation of distal toe tissue from the great and(or)second toe.Methods A series of 126 cages with 141 end section degree thumb and fnger defect were reconstrustructed.Of those,79 were thumb defect,37 index finger,19 middle finger and 6 ring finger.In 15 cages,two digits were reconstmstructed simultaneously at the same setting.For thumb reconstruction,the donor transplants were harvested from great toe in 34 cages,from 2nd toe in 45 case. Forty-five fingers reconstruction cases were taken from 2nd toe.14 fingers from 3th toe and 4 fingers from 4th toe.Results Postoperative arterial crisis occurred in 16 digits and venous crisis in 9.All digits survived after operation and medication treatment.Thirty-one digits underwent secondary plastic operation for better cosmetic effect.Ninety-four digits in 87 cases followed-up from 6 months to 15 years revealed good pulp pinch function.Sensation recovery to S3 and above in 89 cases(94 digits)and two-point discrimination from 6-8 mm in 76 digits.The patients were satisfied with the appearance of the reconstructed thumb and fingers.There were no major complication in the donor toes.Conclusion The defect of distal segment and finger tip of thumb and(or)finger Can be reconstructed by transplantation of partial tissues from the great,2th,3rd or(and)4th toe.The operation will not be influenced by anomMy of the blood vessels.Both ultimate function and cosmetic effect Can meet the patients desire.