以趾腓侧趾背动脉供血的趾甲床瓣修复手指甲床中央纵形缺损
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摘要
目的探讨以趾腓侧趾背动脉供血的趾甲床瓣修复手指甲床中央纵形缺损的方法及临床疗效。方法 2012年5月—2017年2月,应用以趾腓侧趾背动脉供血的趾甲床瓣修复手指甲床中央纵形缺损7例(7指)。男3例,女4例;年龄17~35岁,平均27岁。致伤原因:切割伤2例,电刨伤3例,摩擦伤2例。损伤指别:拇指3例,示指3例,中指1例。缺损范围12 mm×8 mm~21 mm×13 mm。受伤至入院时间为1~2 h,平均1.5 h。甲床瓣切取范围14 mm×10 mm~23 mm×15 mm。供区直接缝合3例,游离植皮修复4例。结果术后甲床瓣及供区植皮均顺利成活,创面均Ⅰ期愈合。患者均获随访,随访时间9~36个月,平均23个月。拇、手指指甲生长平整、有光泽、外形饱满。术后9个月测量甲床瓣皮肤两点辨别觉为7~9 mm,平均8 mm。参照Zook等甲床修复评定标准:获优6例、良1例,优良率达100%。结论以趾腓侧趾背动脉供血的趾甲床瓣修复手指甲床中央纵形缺损可获得较好疗效。
Objective To explore the surgical method and effectiveness of the great toenail bed flap supplied with the fibular dorsal artery of great toe in repair of the finger nail bed central longitudinal defect. Methods Between May2012 and February 2017, 7 cases(7 fingers) with the finger nail bed central longitudinal defects were repaired with the great toenail bed flap supplied with the fibular dorsal artery of great toe. There were 3 males and 4 females; the age ranged from 17 to 35 years(mean, 27 years). The cause of injury included cutting injury in 2 cases, electric shaving injury in3 cases, and frictional injury in 2 cases. The defect located at thumb in 3 cases, index finger in 3 cases, and middle finger in1 case. The defect area ranged from 12 mm×8 mm to 21 mm×13 mm. The time from injury to admission was 1-2 hours(mean, 1.5 hours). The area of the great toenail bed flap ranged from 14 mm×10 mm to 23 mm×15 mm. The wound of donor site was directly sutured in 3 cases and repaired with full thickness skin graft in 4 cases. Results All the great toenail bed flaps and skin grafts at the donor sites survived; and all wounds healed by first intention. All patients were followed up 9 to 36 months(mean, 23 months). The finger nails were smooth and shiny and recovered ideal appearance.At 9 months after operation, the two-point discrimination of the skin ranged from 7 to 9 mm(mean, 8 mm). According to the standard evaluation for nail bed repair issued by Zook etc., 6 cases were rated as excellent and 1 case as good, and the excellent and good rate was 100%. Conclusion It is an ideal method to repair the finger nail bed central longitudinal defect with the great toenail bed flap supplied with the fibular dorsal artery of the great toe.
Objective To explore the surgical method and effectiveness of the great toenail bed flap supplied with the fibular dorsal artery of great toe in repair of the finger nail bed central longitudinal defect. Methods Between May2012 and February 2017, 7 cases(7 fingers) with the finger nail bed central longitudinal defects were repaired with the great toenail bed flap supplied with the fibular dorsal artery of great toe. There were 3 males and 4 females; the age ranged from 17 to 35 years(mean, 27 years). The cause of injury included cutting injury in 2 cases, electric shaving injury in3 cases, and frictional injury in 2 cases. The defect located at thumb in 3 cases, index finger in 3 cases, and middle finger in1 case. The defect area ranged from 12 mm×8 mm to 21 mm×13 mm. The time from injury to admission was 1-2 hours(mean, 1.5 hours). The area of the great toenail bed flap ranged from 14 mm×10 mm to 23 mm×15 mm. The wound of donor site was directly sutured in 3 cases and repaired with full thickness skin graft in 4 cases. Results All the great toenail bed flaps and skin grafts at the donor sites survived; and all wounds healed by first intention. All patients were followed up 9 to 36 months(mean, 23 months). The finger nails were smooth and shiny and recovered ideal appearance.At 9 months after operation, the two-point discrimination of the skin ranged from 7 to 9 mm(mean, 8 mm). According to the standard evaluation for nail bed repair issued by Zook etc., 6 cases were rated as excellent and 1 case as good, and the excellent and good rate was 100%. Conclusion It is an ideal method to repair the finger nail bed central longitudinal defect with the great toenail bed flap supplied with the fibular dorsal artery of the great toe.
引文
1 Morrison WA,O'Brien BM,Macled AM. Thumb reconstruction with a free neurovascular wrap-around flap from the big toe. J Hand Surg(Am), 1980, 5(6):575-583.
2于昆仑,张英泽,田德虎,等.带部分甲床的趾腓侧皮瓣急诊修复拇指末节侧方皮肤软组织及甲床缺损.中华显微外科杂志,2015,38(1):38-40.
3马立峰,李木卫,李国松,等.吻合血管的(趾)甲瓣移植修复拇及手指甲床缺损.中华显微外科杂志,2015, 38(2):116-119.
4周健辉,李秀文,冷树立,等.跟甲皮瓣再造指端及供区修复的改良方法.中华手外科杂志,2017, 3(4):279-281.
5李春华,刘丹,苏波,等.甲弧影以远的指尖损伤修复再造33例.中华显微科杂志,2018, 41(3):260-261.
6刘铭波,谢卫勇,赵波,等.游离趾腓背侧甲床皮瓣修复手指甲床缺损.中华手外科杂志,2014, 30(6):409-410.
7郑晓菊,王保山,宋文斌,等.半趾甲瓣移植修复手指末节缺损.中华显微外科杂志,2012, 35(3):198-200.
8 Zook EG, Guy RJ, Russell RC, et al A study of nail bed injuries:Cause, treatment, and prognosis. J Hand Surg, 1984, 9(2):247-252.
9徐达传,蔡锦方,赵志杰,等.指、趾甲复合瓣移植的解剖学基础.中国临床解剖学杂志,1989, 7(1):12-15.
10王增涛,王一兵,丁自海.显微外科临床解剖学图谱.济南:山东科学技术出版社,2009:782.
11劳杰,左焕深,陈德松,等.拇指甲床游离移植的应用解剖.中华手外科杂志,1994, 10(4):231-232.
12牟勇,黄东,吴伟炽,等.以趾背动脉为血供的趾背皮瓣应用解剖.中国临床解剖学杂志,2010, 28(6):618-619.
13吴春,谭莉,应建军,等.吻合血管的微型趾断层甲床皮瓣修复拇手指末节软组织缺损.中华手外科杂志,2017, 33(5):389-390.
14李木卫,吴巩,罗朝晖,等.吻合血管的第二趾部分甲床瓣修饰性修复手指甲床缺损.中华显微外科杂志,2017, 40(5):445-448.
15张键,黄剑,潘佳栋,等.拇手指再造的多组织移植术后血管危象探讨.中国修复重建外科杂志,2017, 31(3):323-326.
2于昆仑,张英泽,田德虎,等.带部分甲床的趾腓侧皮瓣急诊修复拇指末节侧方皮肤软组织及甲床缺损.中华显微外科杂志,2015,38(1):38-40.
3马立峰,李木卫,李国松,等.吻合血管的(趾)甲瓣移植修复拇及手指甲床缺损.中华显微外科杂志,2015, 38(2):116-119.
4周健辉,李秀文,冷树立,等.跟甲皮瓣再造指端及供区修复的改良方法.中华手外科杂志,2017, 3(4):279-281.
5李春华,刘丹,苏波,等.甲弧影以远的指尖损伤修复再造33例.中华显微科杂志,2018, 41(3):260-261.
6刘铭波,谢卫勇,赵波,等.游离趾腓背侧甲床皮瓣修复手指甲床缺损.中华手外科杂志,2014, 30(6):409-410.
7郑晓菊,王保山,宋文斌,等.半趾甲瓣移植修复手指末节缺损.中华显微外科杂志,2012, 35(3):198-200.
8 Zook EG, Guy RJ, Russell RC, et al A study of nail bed injuries:Cause, treatment, and prognosis. J Hand Surg, 1984, 9(2):247-252.
9徐达传,蔡锦方,赵志杰,等.指、趾甲复合瓣移植的解剖学基础.中国临床解剖学杂志,1989, 7(1):12-15.
10王增涛,王一兵,丁自海.显微外科临床解剖学图谱.济南:山东科学技术出版社,2009:782.
11劳杰,左焕深,陈德松,等.拇指甲床游离移植的应用解剖.中华手外科杂志,1994, 10(4):231-232.
12牟勇,黄东,吴伟炽,等.以趾背动脉为血供的趾背皮瓣应用解剖.中国临床解剖学杂志,2010, 28(6):618-619.
13吴春,谭莉,应建军,等.吻合血管的微型趾断层甲床皮瓣修复拇手指末节软组织缺损.中华手外科杂志,2017, 33(5):389-390.
14李木卫,吴巩,罗朝晖,等.吻合血管的第二趾部分甲床瓣修饰性修复手指甲床缺损.中华显微外科杂志,2017, 40(5):445-448.
15张键,黄剑,潘佳栋,等.拇手指再造的多组织移植术后血管危象探讨.中国修复重建外科杂志,2017, 31(3):323-326.