Hirase Yuichi, Kanno Yuri, Okubo Arisa, Onozawa Hisasuke, Yagishita Mikio, Yamada Tetsuo
Department of Hand Surgery and Microsurgery, Yotsuya Medical Cube, Tokyo, Japan.
Microsurgery. 2023 Mar;43(3):222-228. doi: 10.1002/micr.30982. Epub 2022 Nov 11.
Although aesthetic reconstruction of an amputated distal finger can be achieved through partial toe transfer, this approach often damages the weight-bearing region of the toe from which the flap is harvested. The purpose of this report is to introduce the minimum invasive surgery technique to reconstruct the distal finger aesthetically without damaging the weight-bearing region of the toe.
Thirty-one amputated fingertips in 30 patients aged 18 to 68 years were treated using this operative technique. Operations were performed between January 2010 and December 2020. All patients were missing the distal finger beyond the PIP joint, and the amputation stump had been covered with healthy skin. A distally based finger flap was elevated at the recipient site, and a slender partial toe flap, including the nail, was harvested from the great toe. These flaps were combined to form the distal finger. In all cases, the weight-bearing region of the toe remained intact. The donor site wound was first closed with artificial dermis, and skin grafting was performed 3 weeks after the surgery. A few patients did not require skin grafting because their wounds epithelized spontaneously.
In most patients, the transplanted flap remained healthy and the distal finger was aesthetically restored. Two patients aged over 60 years who were smokers developed necrosis of the transplanted partial toe flap. In all patients, the weight-bearing region of the great toe was intact, and they had no trouble walking during the three-year follow-up period after surgery.
Our technique, which combines elevation of a distally-based finger flap and transplantation of a partial toe flap, was able to minimize the skin defect area in the great toe. This new distal finger reconstruction technique is minimally invasive and can be used to prevent secondary donor site issues.
尽管通过部分足趾移植可以实现断指远节的美学重建，但这种方法常常会损害用于切取皮瓣的足趾的负重区域。本报告的目的是介绍一种微创手术技术，用于在不损害足趾负重区域的情况下对远节手指进行美学重建。
采用该手术技术治疗了30例年龄在18至68岁之间患者的31个断指指尖。手术于2010年1月至2020年12月期间进行。所有患者的手指均在近端指间关节（PIP）以远缺失，且断端残肢已被健康皮肤覆盖。在受区掀起一个远端蒂手指皮瓣，并从拇趾切取一个包括趾甲的细长部分足趾皮瓣。将这些皮瓣组合形成远节手指。在所有病例中，足趾的负重区域均保持完整。供区伤口首先用人造真皮封闭，术后3周进行植皮。少数患者因伤口自行上皮化而无需植皮。
在大多数患者中，移植皮瓣保持健康，远节手指获得美学修复。2例60岁以上的吸烟患者出现移植部分足趾皮瓣坏死。在所有患者中，拇趾的负重区域均保持完整，且在术后三年的随访期内行走无困难。
我们的技术，即结合远端蒂手指皮瓣掀起和部分足趾皮瓣移植，能够使拇趾的皮肤缺损面积最小化。这种新的远节手指重建技术微创，可用于预防供区的继发问题。
