Department of Hand Surgery, Wuxi Hand Surgery and Orthopaedics Hospital, Wuxi City, Jiangsu Province, China.
Microsurgery. 2010 Sep;30(6):449-56. doi: 10.1002/micr.20777.
Surgical procedure of great toe wrap-around flap combined with second toe medial flap free transfer for reconstructing completely degloved fingers was introduced. The treatment outcomes were evaluated. 10 fingers in 7 cases were involved in this series. The great toe wrap-around flap with dorsalis pedis skin covered the dorsal and most palmar side of the injured finger. The second toe medial flap covered the proximal palmar portion of the finger. The combined flap was revascularized with nerve repair. Rehabilitation started two weeks postoperatively. All flaps survived except one was partial failure due to distal phalange necrosis. Recipient areas achieved primary wound healing in 9 fingers. Skin graft at donor site achieved primary survival except delayed healing in one case. All patients were followed-up from 34 to 76 months. The appearance of reconstructed fingers was satisfactory. Nail growth well except that one nail was the atrophic and another was defect. Range of active motion in the metacarpophalangeal joint was from 60° to 80° and the proximal interphalange joint was 40° to 70°. Two-point discrimination was between 8 mm and 12 mm. All patients walked with no interference. There was no pain and no swelling at donor site. According to the results, this procedure is recommended to reconstruct total degolving finger which has intact phalanges and tendons.
介绍了一种采用踇趾环绕皮瓣联合第二趾胫侧皮瓣游离移植修复完全脱套手指的手术方法，并对其治疗效果进行了评估。本研究共纳入 7 例 10 指患者，其中 9 指的踇趾环绕皮瓣携带足背皮瓣覆盖患指的背侧和大部分掌侧，第二趾胫侧皮瓣覆盖指近节掌侧，皮瓣均携带趾神经修复重建。术后 2 周开始康复治疗。除 1 指因末节指骨坏死导致皮瓣部分坏死外，其余皮瓣均完全成活。9 指受区创面均一期愈合，供区皮片除 1 例延迟愈合外均一期成活。所有患者均获随访，随访时间 34 ～ 76 个月。再造手指外形满意，指甲生长良好，仅 1 例指甲萎缩，1 例指甲缺损。掌指关节活动度为 60° ～ 80°，近侧指间关节活动度为 40° ～ 70°，两点辨别觉为 8 ～ 12mm。患者均能正常行走，无供区疼痛及肿胀。综上所述，该方法适用于修复存在完整指骨和肌腱的完全脱套手指。
