查看更多>>摘要：目的 探讨应用趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损的临床效果。 方法 自2019年1月至2022年6月,北京积水潭医院贵州医院上肢修复重建外科设计以同一趾供区第1跖背动脉为蒂的趾腓侧分叶穿支皮瓣拆分为趾背动脉皮瓣、趾底动脉皮瓣移植修复多发指端缺损15例,其中男10例,女5例，年龄20~45岁 拇、示指指端缺损8例,拇、中指指端缺损4例,拇、示、中指指端缺损2例,拇、示、环指指端缺损1例；15例多指指端缺损病例中均有1指合并需修复的甲床缺损。趾腓侧趾背动脉皮瓣切取面积1.8 cm×2.0 cm~2.0 cm×3.1 cm，趾底动脉皮瓣切取面积1.5 cm×2.0 cm~2.5 cm×3.0 cm。趾供区均以游离旋髂浅动脉穿支皮瓣修复。术后通过门诊、微信、电话随访手指外形、功能、感觉恢复情况。随访截止时间：2023年6月30日。 结果 本组15例皮瓣全部成活。术后随访6~24（平均16）个月,所有皮瓣外观、质地与健侧手指接近，指甲生长良好无畸形，皮瓣TPD为8.0~12.0 mm，足部供区旋髂浅动脉穿支皮瓣均成活，切口均愈合良好，供足行走、跑跳功能均未见明显影响。 结论 应用趾腓侧分叶穿支皮瓣拆分移植修复多发指端缺损，血管走行恒定，皮瓣切取简便，皮瓣质地接近正常手指，皮瓣可携带甲床，一个皮瓣供区可一次性修复两处指端缺损，是修复多发手指指端中、小面积复合组织缺损的一种较理想方法。 Objective To evaluate the clinical effectiveness of the reconstruction of multiple digit-tip defects with transfer of polyfoliate perforator flaps of the fibular hallux. Methods From January 2019 to June 2022, 15 patients had undergone reconstruction surgery for multiple digit-tip defects using polyfoliate perforator flaps of ipsilateral fibular hallux, with the first dorsal metatarsal artery as the pedicle, in the Department of Upper Limb Repair and Reconstruction Surgery, Guizhou Hospital of Beijing Jishuitan Hospital. The patients were 10 males and 5 females and aged 20 to 45 years old. Eight patients had the defects of thumbs and index fingers, 4 of thumbs and middle fingers, 2 of thumb, index and middle fingers and 1 of thumb, index and ring fingers. All the 15 digit injuries had nail bed defects to which reconstructive surgery were required. For the flaps of dorsal artery, flaps were 1.8 cm×2.0 cm-2.0 cm×3.1 cm in size and for those of plantar artery, the flaps sized 1.5 cm×2.0 cm-2.5 cm×3.0 cm. Donor site defects in the hallux were reconstructed with free superficial circumflex iliac perforator flaps. Postoperative follow-up lasted until 30th June 2023 and included visits to the outpatient clinic, WeChat and telephone reviews to assess the appearance, function and sensation recovery of the digits. Results All the 15 flaps survived. During the 6 to 24 months (16 months in average) of postoperative follow-up, the appearance and texture of all flaps were found close to the healthy digits, with good nail growth and without deformity. TPD were found between 8.0 mm and 12.0 mm. The donor sites on the great toes that reconstructed with superficial circumflex iliac artery flaps were all survived well, and the incisions were satisfactorily healed without the functions of walking, running or jumping being significantly affected. Conclusion The use of polyfoliate perforator flaps of fibular hallux for reconstruction of multiple digit-tip defects is an ideal surgical method due to the consistency of vascular anatomy, ease with flap harvest, similarity in the normal digital skin texture, and the capability to include a nail bed with the flap. A single donor from the hallux can simultaneously reconstruct two defects of digit-tip, making it an excellent treatment in the reconstruction of small-to medium-sized composite tissue defects in multiple digits.
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