Yang T, Chen J, Cheng B B, Wang S, Jiang X M, Song L, Zhou M W, Li S M
Department of Trauma and Microsurgery, the 988th Hospital of Joint Logistic Support Force of PLA, Zhengzhou 450042, China.
Zhonghua Shao Shang Za Zhi. 2021 Sep 20;37(9):875-879. doi: 10.3760/cma.j.cn501120-20200727-00360.
To investigate the clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand. The retrospective observational study method was used. From May 2014 to June 2019, 8 patients with thumb damage and soft tissue defect of hand were admitted to the 988th Hospital of Joint Logistic Support Force of PLA, including 6 males and 2 females, aged from 25 to 46 years. Among them, thumb damage in 3 cases were degree Ⅱ, 1 case was degree Ⅲ, and 4 cases were degree Ⅳ. All thumb damage were repaired with perforator flap combined with toe transplantation. The skin and soft tissue defects of hand were repaired by free anterolateral thigh perforator flap in 6 cases and free deep inferior epigastric perforator flap in 2 cases. The thumb damage of degree Ⅱ was repaired by the first toe transplantation combined with perforator flap, and thumb damage of degree Ⅲ or Ⅳ was repaired by the second toe transplantation combined with perforator flap. The survival and blood supply of reconstructed thumbs and flaps, and wound healing of donor sites were observed after surgery. All the patients were followed up for 10 to 18 months, the appearance of the reconstructed thumbs, sensory recovery, and foot walking function were observed. At the final follow-up, the functional reconstruction of the thumb was evaluated. All the blood supply and survival of the reconstructed thumbs and flaps were good, and all the wounds of donor sites healed well. During the follow-up, the appearances of the reconstructed thumb and flap were good, the sensation of pain and touch of the finger pulp recovered well, and no significant impact on foot walking function was observed. At the final follow-up, the function of reconstructed thumb was evaluated as excellent in 4 cases, good in 3 cases, and fair in 1 case. The repair method of perforator flap combined with toe transplantation technique can complete the targeted repair of thumb damage with skin and soft tissue defect of hand in one stage, minimizing the foot donor site injury and shortening the course of disease and early rehabilitation, which is one of the ideal methods for the treatment of complex thumb damage.
探讨穿支皮瓣联合足趾移植修复拇指损伤伴手部软组织缺损的临床效果。采用回顾性观察研究方法。2014年5月至2019年6月，解放军联勤保障部队第988医院收治8例拇指损伤伴手部软组织缺损患者，其中男6例，女2例，年龄25～46岁。其中，Ⅱ度拇指损伤3例，Ⅲ度1例，Ⅳ度4例。均采用穿支皮瓣联合足趾移植修复拇指损伤。手部皮肤软组织缺损6例采用游离股前外侧穿支皮瓣修复，2例采用游离腹壁下深穿支皮瓣修复。Ⅱ度拇指损伤采用第一足趾移植联合穿支皮瓣修复，Ⅲ度或Ⅳ度拇指损伤采用第二足趾移植联合穿支皮瓣修复。术后观察再造拇指及皮瓣的存活及血运情况，供区伤口愈合情况。所有患者随访10～18个月，观察再造拇指外观、感觉恢复及足部行走功能。末次随访时，对拇指功能重建进行评价。所有再造拇指及皮瓣血运及存活良好，供区伤口均愈合良好。随访期间，再造拇指及皮瓣外观良好，指腹痛觉及触觉恢复良好，对足部行走功能无明显影响。末次随访时，再造拇指功能评价为优4例，良3例，可1例。穿支皮瓣联合足趾移植技术修复方法可一期完成拇指损伤伴手部皮肤软组织缺损的靶向修复，最大限度减少足部供区损伤，缩短病程及早期康复时间，是治疗复杂拇指损伤的理想方法之一。
