Shibata M, Seki T, Yoshizu T, Saito H, Tajima T
Department of Orthopaedics, Niigata University School of Medicine.
Plast Reconstr Surg. 1991 Jul;88(1):102-9; discussion 110.
Free nonvascularized toenail grafts have been used to reconstruct congenital or traumatic nail defects of the thumb or finger. Unfortunately, these transfers often result in deformity or atrophy. To avoid these undesirable results, microsurgical free vascularized toenail transfer was performed in 10 patients, 3 for congenital nail absence and 7 for traumatic nail defects. Patient age averaged 17 years (range 2 to 32 years). In contrast with previous reports, the whole big or second toenail complex without pulp was used in reconstruction. All 10 nails were successfully transferred with complete survival. No digits required reexploration. There were no donor- or recipient-site problems. Follow-up averaged 3 years, with a range of 14 months to 5 years and 4 months. Appropriate nail growth occurred in the congenital patients. No atrophy of the nail complex was found as long as sufficient bony support was present (9 of 10 cases). Whole free vascularized toenail transfers for reconstruction of congenital and traumatic nailbed defects achieve excellent aesthetic results while maintaining normal hand function.
游离无血管化趾甲移植已被用于重建拇指或手指的先天性或创伤性指甲缺损。不幸的是，这些移植往往会导致畸形或萎缩。为避免这些不良后果，对10例患者进行了显微外科游离血管化趾甲移植，其中3例为先天性指甲缺失，7例为创伤性指甲缺损。患者平均年龄为17岁（范围为2至32岁）。与以往报道不同的是，在重建中使用了完整的无甲床的大趾甲或第二趾甲复合体。所有10枚趾甲均成功移植且完全存活。无需对任何手指进行再次探查。供区和受区均未出现问题。随访平均3年，范围为14个月至5年4个月。先天性患者的趾甲生长正常。只要有足够的骨质支撑（10例中有9例），未发现趾甲复合体萎缩。游离血管化全趾甲移植用于重建先天性和创伤性甲床缺损，在保持手部正常功能的同时，可获得极佳的美学效果。
