目的 探讨对等设计微型甲瓣整形性修复手指尖毁损伤的临床疗效。 方法 病例系列报告。纳入2015年5月—2020年5月海军第971医院及青岛市市立医院收治的应用对等设计微型甲瓣进行整形性修复的手指尖毁损伤患者56例（56指）。56例患者中，男36例，女20例，年龄30~50（40.2±5.4）岁；拇指指尖毁损20例，示指指尖毁损17例，中指指尖毁损10例，环指指尖毁损9例；门挤压伤36例、机器挤压伤20例。指尖软组织缺损范围为0.60 cm×1.00 cm~0.80 cm×1.50 cm，甲床缺损0.40 cm×0.70 cm~0.60 cm×0.80 cm。受伤至手术时间为2~7（4.8±1.4）h。对等设计微型甲瓣的大小为0.71 cm×1.22 cm~0.88 cm×1.71 cm。记录手术情况及术后并发症，计算甲瓣成活率。术后定期随访，记录指甲生长时间，观察手指外观及质地；按照Zook甲床修复评定标准评价指甲修复情况，记录Semmes-Weinstein触压觉、两点分辨觉；应用中华医学会手外科学会上肢部分功能评定试用标准评价手术疗效。 结果 所有患者手术顺利，手术时间2~5（3.5±0.6）h，术中出血量13~27（20.7±4.9）mL；56指移植瓣全部成活，成活率100%。1例患者于术后48 h发生静脉危象，2例患者分别于术后13、17 h发生动脉危象，经手术处理后均成活。所有患者随访20~45（30.8±11.2）个月，指甲生长总时间为6~13（9.7±2.1）个月。末次随访时，56例患者指甲生长正常、指腹螺纹及精细感觉均恢复，指甲无畸形、外形美观逼真，皮瓣外形质地良好，保护性感觉恢复；Zook甲床修复评定标准优38例、良18例，优良率100%；Semmes-Weinstein触压觉0.1~0.2（0.32±0.14）g，两点分辨觉5~9（7.33±1.02）mm；根据中华医学会手外科学会上肢部分功能评定试用标准评定疗效，优秀46例、良好10例，优良率100%。 结论 对等设计微型甲瓣整形性修复手指尖毁损伤手术供区损伤小、毁损手指尖外形美观且功能恢复良好，是治疗指尖毁损伤的有效手术方法。 Objective This study aims to explore the clinical effect of plastic repair of fingertip injury with equivalent mini toenail flap. Methods This case series report with retrospective analysis was conducted on 56 patients (56 fingers) with fingertip injuries treated with equivalent design mini toenail flaps for plastic repair at the No. 971 Hospital of the People's Liberation Arm and Qingdao Municipal Hospital from May 2015 to May 2020. The patients included 36 males and 20 females, aged 30-50 (40.2±5.4) years. Twenty patients had thumb fingertip damage, 17 patients had index fingertip damage, 10 patients had middle fingertip damage, and 9 patients had ring fingertip damage. Moreover, 36 patients had door crush injury and 20 patients had machine crush injury. Fingertip soft tissue defects ranged from 0.60 cm×1.00 cm to 0.80 cm×1.50 cm, and nail bed defects ranged from 0.40 cm×0.70 cm to 0.60 cm × 0.80 cm. The time from injury to operation was 2-7 (4.8±1.4) h. The size of the equivalently designed mini toenail flap was 0.71 cm×1.22 cm to 0.88 cm×1.71 cm. The operative conditions and postoperative complications were recorded and the survival rate of great nail flap was calculated. At the last follow-up, the appearance and texture of fingers were observed. Nail repair was evaluated according to Zook nail-bed repair evaluation criteria. Semmes-Weinstein touch pressure sense and two-point resolution sense were recorded. The trial criteria of upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association were used to evaluate the surgical effect. Results All patients underwent surgery smoothly, with a duration of 2-5 (3.5±0.6) h and intraoperative bleeding of 13-27 (20.7±4.9) mL. All 56 fingers survived, with a survival rate of 100%. One patient developed venous crisis 48 h after surgery, and two patients developed arterial crisis 13 h and 17 h after surgery. All patients survived after surgery. The postoperative follow-up was 20-45 (30.82±11.21) months, and the total nail growth time was 6-13 (9.68±2.11) months. At the last follow-up, 56 patients recovered nail growth, finger thread and fine sensation, no nail malformation, beautiful and realistic appearance, good skin flap shape and texture, and protective sensation. According to the Zook nail bed repair evaluation standard, 38 patients were excellent, 18 patients were good, and the excellent and good rate was 100%. The Semmes Weinstein tactile sense was 0.1-0.2 (0.32±0.14) g, and the two-point resolution angle was 5-9 (7.33±1.02) mm. According to the trial criteria of upper limb function evaluation of the Hand Surgery Society of the Chinese Medical Association, 46 patients were excellent, 10 patients were good, and the excellent and good rate was 100%. Conclusion The plastic repair of fingertip injury with equivalent mini toenail flap has little damage in the donor area, beautiful appearance, and good functional recovery hence, it is an effective surgical method for the treatment of fingertip damages.
Effect of plastic repair of fingertip injury with equivalent design mini toenail flap
Objective This study aims to explore the clinical effect of plastic repair of fingertip injury with equivalent mini toenail flap. Methods This case series report with retrospective analysis was conducted on 56 patients (56 fingers) with fingertip injuries treated with equivalent design mini toenail flaps for plastic repair at the No. 971 Hospital of the People's Liberation Arm and Qingdao Municipal Hospital from May 2015 to May 2020. The patients included 36 males and 20 females, aged 30-50 (40.2±5.4) years. Twenty patients had thumb fingertip damage, 17 patients had index fingertip damage, 10 patients had middle fingertip damage, and 9 patients had ring fingertip damage. Moreover, 36 patients had door crush injury and 20 patients had machine crush injury. Fingertip soft tissue defects ranged from 0.60 cm×1.00 cm to 0.80 cm×1.50 cm, and nail bed defects ranged from 0.40 cm×0.70 cm to 0.60 cm × 0.80 cm. The time from injury to operation was 2-7 (4.8±1.4) h. The size of the equivalently designed mini toenail flap was 0.71 cm×1.22 cm to 0.88 cm×1.71 cm. The operative conditions and postoperative complications were recorded and the survival rate of great nail flap was calculated. At the last follow-up, the appearance and texture of fingers were observed. Nail repair was evaluated according to Zook nail-bed repair evaluation criteria. Semmes-Weinstein touch pressure sense and two-point resolution sense were recorded. The trial criteria of upper limb partial function evaluation of the Hand Surgery Society of the Chinese Medical Association were used to evaluate the surgical effect. Results All patients underwent surgery smoothly, with a duration of 2-5 (3.5±0.6) h and intraoperative bleeding of 13-27 (20.7±4.9) mL. All 56 fingers survived, with a survival rate of 100%. One patient developed venous crisis 48 h after surgery, and two patients developed arterial crisis 13 h and 17 h after surgery. All patients survived after surgery. The postoperative follow-up was 20-45 (30.82±11.21) months, and the total nail growth time was 6-13 (9.68±2.11) months. At the last follow-up, 56 patients recovered nail growth, finger thread and fine sensation, no nail malformation, beautiful and realistic appearance, good skin flap shape and texture, and protective sensation. According to the Zook nail bed repair evaluation standard, 38 patients were excellent, 18 patients were good, and the excellent and good rate was 100%. The Semmes Weinstein tactile sense was 0.1-0.2 (0.32±0.14) g, and the two-point resolution angle was 5-9 (7.33±1.02) mm. According to the trial criteria of upper limb function evaluation of the Hand Surgery Society of the Chinese Medical Association, 46 patients were excellent, 10 patients were good, and the excellent and good rate was 100%. Conclusion The plastic repair of fingertip injury with equivalent mini toenail flap has little damage in the donor area, beautiful appearance, and good functional recovery hence, it is an effective surgical method for the treatment of fingertip damages.
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