（母）甲瓣修复拇指脱套伤的临床研究
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摘要
目的
通过与传统方法对比,探讨应用(?)甲瓣修复拇指脱套伤的优缺点及临床疗效。
方法
对2009-01-01至2011-08-31接受(?)甲皮瓣移植再造拇指的13例患者进行外观、功能恢复探讨,其中急诊再造5例,亚急诊再造8例。并对经传统手术修复的13例患者进行回顾总结对比研究。
结果
13例再造拇指全部成活,随访时间6-30个月,平均10个月。再造拇指外形美观,对掌活动灵活,拇指抓、握、捏均有力,按中华医学会手外科学会拇、手指再造功能评定试用标准评定,实验组优良率为：92.3%；对照组优良率为：61.5%。实验组两点辨别觉为(8.0±1.5)mm,与对照组(10.5±1.9)mm比较差异有统计学意义(P<0.05)。患者对再造拇指外观均满意。供区(?)甲瓣切取后植皮或皮瓣全部成活,术后对供足的站立行走及负重功能无明显影响。
结论
(?)甲瓣修复拇指脱套伤具有外形美观、逼真,活动及感觉功能恢复好,对供区外形、功能影响小及一次完成手术等优点,是现阶段修复拇指脱套伤的一种理想有效方法。
Objective
Compared with the traditional operation, explore the advantages and disadvantages of Transplanting Wrap-around Flap from the Big Toe to repair the thumb degloving injuries and clinical curative effect.
Methods
From January.2009to August.2011, all13cases who have accepted transplanting Wrap-around Flap from the Big Toe were explored the appearance and functional recovery, emergency reconstructing in5cases, and sub-emergency reconstructing8cases. And13cases which have repaired by the traditional surgical in the past were contrasted research.
Results
All the thumbs of13cases were survived, which were followed-up from6～30months, average10months. Reconstructing the thumb has beautiful appearance, flexible to palm activities, and the thumb catch, hold, knead was powerful. According to the association of university learn to thumb or finger renew function evaluation standard trial evaluation, the experimental group was for:92.3%; The control group was for:61.5%. Two-point discrimination was8.0±1.5mm. and the control group was10.5±1.9mm, comparing statistical significance (P<0.05). Patients are satisfied with reconstructing thumb. It's all survived to reconstructing the skin grafts or flaps on donor area, and to stand for the foot walk and weight function not significantly influenced.
Conclusion
It's a kind of ideal effective methods to repair thumb degloving injuries by transplanting wrap-around flap from the big toe. This operation has less damage on donor area, and reconstructive thumb has a nice and lifelike appearance and good activities and feel functional recovery.
通过与传统方法对比,探讨应用(?)甲瓣修复拇指脱套伤的优缺点及临床疗效。
方法
对2009-01-01至2011-08-31接受(?)甲皮瓣移植再造拇指的13例患者进行外观、功能恢复探讨,其中急诊再造5例,亚急诊再造8例。并对经传统手术修复的13例患者进行回顾总结对比研究。
结果
13例再造拇指全部成活,随访时间6-30个月,平均10个月。再造拇指外形美观,对掌活动灵活,拇指抓、握、捏均有力,按中华医学会手外科学会拇、手指再造功能评定试用标准评定,实验组优良率为：92.3%；对照组优良率为：61.5%。实验组两点辨别觉为(8.0±1.5)mm,与对照组(10.5±1.9)mm比较差异有统计学意义(P<0.05)。患者对再造拇指外观均满意。供区(?)甲瓣切取后植皮或皮瓣全部成活,术后对供足的站立行走及负重功能无明显影响。
结论
(?)甲瓣修复拇指脱套伤具有外形美观、逼真,活动及感觉功能恢复好,对供区外形、功能影响小及一次完成手术等优点,是现阶段修复拇指脱套伤的一种理想有效方法。
Objective
Compared with the traditional operation, explore the advantages and disadvantages of Transplanting Wrap-around Flap from the Big Toe to repair the thumb degloving injuries and clinical curative effect.
Methods
From January.2009to August.2011, all13cases who have accepted transplanting Wrap-around Flap from the Big Toe were explored the appearance and functional recovery, emergency reconstructing in5cases, and sub-emergency reconstructing8cases. And13cases which have repaired by the traditional surgical in the past were contrasted research.
Results
All the thumbs of13cases were survived, which were followed-up from6～30months, average10months. Reconstructing the thumb has beautiful appearance, flexible to palm activities, and the thumb catch, hold, knead was powerful. According to the association of university learn to thumb or finger renew function evaluation standard trial evaluation, the experimental group was for:92.3%; The control group was for:61.5%. Two-point discrimination was8.0±1.5mm. and the control group was10.5±1.9mm, comparing statistical significance (P<0.05). Patients are satisfied with reconstructing thumb. It's all survived to reconstructing the skin grafts or flaps on donor area, and to stand for the foot walk and weight function not significantly influenced.
Conclusion
It's a kind of ideal effective methods to repair thumb degloving injuries by transplanting wrap-around flap from the big toe. This operation has less damage on donor area, and reconstructive thumb has a nice and lifelike appearance and good activities and feel functional recovery.
引文
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[16]眭述平,曾炳芳,范存义,等.急诊游离(?)趾甲皮瓣修复或重建拇指[J].中华手外科杂志,1999,15(2)：80-81.
[17]潘勇卫,田文,田光磊,等.改良游离甲皮瓣移植再造拇指.中华手外科杂志,2005,21(2)：79-83.
[18]Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defectsafter wrap-around flap transfer with a free soleus perforator flap. J ReconstrMicrosurg,2005,21(4):225-229.
[19]Stupka I, Vesely J, Drazan L, et al. Foot morbidity following toe to hand transfers. Eur J Plast Surg,2004,27(6):283-287.
[20]潘勇卫,栗鹏程,李玉成,等.游离膝上外皮瓣移植覆盖甲皮瓣切除后的创面[J].中华手外科杂志,2007,23(2)：89-92.
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[22]王建广,李少华,蔡郑东。(?)甲瓣切除后供足创面修复的远期随访[J]。同济大学学报,2010,31(1)：94-96。
[23]潘勇卫,田文,田光磊,等.改良游离甲皮瓣移植再造拇指.中华手外科杂志,2005,21(2)：79-83.
[24]王东,凌彤,谭成祥,等.第二跖背动脉逆行岛状皮瓣修复趾甲瓣切除后的创面[J].中华手外科杂志,2000,16(1)：40-42.
[25]张全荣,寿奎水,施海峰,等.改良(?)甲瓣和第二趾胫侧皮瓣瓦和修复拇指脱套伤[J].中国现代医学杂志,2006,16(23)：3666-3667.
[26]闫厚军,杨黎明,皮彦斌,等.保留(?)趾跖底负重区的游离(?)甲瓣移植再造拇指[J].中国煤炭工业医学杂志,2009,12(1)：105-106.
[27]谭海涛,罗翔,江建中,等.应用游离足趾组织移植修复拇指和手指部分缺损[J].中华显微外科杂志,2011,34(2)：98-100.
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[25]李嗣生,孙军,胡兵,等.自体趾尖部分移植再造手指指尖[J],中华手外科杂志,2009,25(3)：169-171.
[26]王欣,章伟文,陈宏,等.部分拇甲瓣移植修复拇指末节半侧缺损[J],中华手外科杂志,2006,22(6)：360-361.
[27]程国良.不同形式的足趾移植拇手指再造与修复[J].中华显微外科杂志,2002,25(1)：8-9.
[28]程国良,潘达德.手指再植与再造[M].北京：人民卫生出版社,1997：276-278.
[29]眭述平,曾炳芳,范存义,等.急诊游离(?)趾甲皮瓣修复或重建拇指[J].中华手外科杂志,1999,15(2)：80-81.
[30]王建广,李少华,蔡郑东。(?)甲瓣切除后供足创面修复的远期随访[J]。同济大学学报,2010,31(1)：94-96。
[31]Yamada N, Kurokawa M, Kakibuchi M, et al. A new idea to avoid complications at the donor site of the wrap-around flap with a tissue expander. Plast Reconstr Surg,2003,112(6) 1744-1745.
[32]潘勇卫,栗鹏程,李玉成,等.游离膝上外皮瓣移植覆盖甲皮瓣切除后的创面[J].中华手外科杂志,2007,23(2)：89-92.
[33]潘勇卫,田文,田光磊,等.改良游离甲皮瓣移植再造拇指.中华手外科杂志,2005,21(2)：79-83.
[34]王东,凌彤,谭成祥,等.第二跖背动脉逆行岛状皮瓣修复趾甲瓣切除后的创面[J].中华手外科杂志,2000,16(1)：40-42.
[35]张全荣,寿奎水,施海峰,等.改良(?)甲瓣和第二趾胫侧皮瓣瓦和 修复拇指脱套伤[J].中国现代医学杂志,2006,16(23)：3666-3667.
[36]闫厚军,杨黎明,皮彦斌,等.保留(?)趾跖底负重区的游离(?)甲瓣移植再造拇指[J].中国煤炭工业医学杂志,2009,12(1)：105-106.
[2]Adani R, Busa R, Castagnettiast Reconstr Surg,1998,101(6) 1544-1551.
[3]Morrison WA,O'Brein BM, Macleod AM. Thumb reconstruction with a free Neurovascular wrap-around flap from the big toe. JH and Surg [Am],1980,5:575-583.
[4]刘东昕,王虎。第一足趾甲瓣治疗拇指脱套伤[J]。中国现代医生,2007,45(7)：23-24.
[5]程国良.不同形式的足趾移植拇手指再造与修复[J].中华显微外科杂志,2002,25(1)：8-9.
[6]程国良,潘达德.手指再植与再造[M].北京：人民卫生出版社,1997：276-278.
[7]谭海涛,林源,梁裔鸿,等.改良(?)甲瓣加第二足趾移植延迟性手再造[J].中华手外科杂志,2000,16(2)：97.
[8]顾玉东.张高孟,陈德松.足趾移植中的血管分型及其临床意义[J].中华手外科杂志,1999。15：67.69.
[9]Malaty HM, Engstrand L, Pedersen NL, et al. Helicobacter pylori infection:genetic and environmental influences. A study of twins[J]. Ann Intern Med,1994,120(12):982-986.
[10]CoconnierMH, Lievin V, Bemet-Camard MF, et al. Antibacterial effect of the adhering human Lactobacillus acidophilus strain LB [J]. Antimicrob Agents Chemother,1997,41(5):1046-1052.
[11]冯亚高,张向宁.保留趾全长的游离甲皮瓣再造拇指[J].实用 手外科杂志,2008,13：169.
[12]侯书健,程国良,方光荣,等.拇指及手指再造手术血管危象164例临床分析.中华显微外科杂志,2005,28(2)：130-132.
[13]李文东,周丹亚,蔡晓明,等.小儿末节断指再植56例临床疗效分析[J].中华手外科杂志,2008,24(5)：316-317.
[14]李嗣生,孙军,胡兵,等.自体趾尖部分移植再造手指指尖[J],中华手外科杂志,2009,25(3)：169-171.
[15]王欣,章伟文,陈宏,等.部分拇甲瓣移植修复拇指末节半侧缺损[J],中华手外科杂志,2006,22(6)：360-361.
[16]眭述平,曾炳芳,范存义,等.急诊游离(?)趾甲皮瓣修复或重建拇指[J].中华手外科杂志,1999,15(2)：80-81.
[17]潘勇卫,田文,田光磊,等.改良游离甲皮瓣移植再造拇指.中华手外科杂志,2005,21(2)：79-83.
[18]Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defectsafter wrap-around flap transfer with a free soleus perforator flap. J ReconstrMicrosurg,2005,21(4):225-229.
[19]Stupka I, Vesely J, Drazan L, et al. Foot morbidity following toe to hand transfers. Eur J Plast Surg,2004,27(6):283-287.
[20]潘勇卫,栗鹏程,李玉成,等.游离膝上外皮瓣移植覆盖甲皮瓣切除后的创面[J].中华手外科杂志,2007,23(2)：89-92.
[21]Yamada N, Kurokawa M, Kakibuchi M, et al. A new idea to avoid complications at the donor site of the wrap-around flap with a tissue expander. Plast Reconstr Surg,2003,112(6): 1744-1745.
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