Precise transplantation and repair technology for fingertip nail bed defects based on toe vascular microanatomy and its application
臧谋圣 1刘自立 1储建军 1孔祥安 1方兴 1李力 1胡斌 1高杰 1张浩 1王剑利 2江烨
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作者信息
1. 1合肥市第二人民医院骨科，合肥 230011
2. 2解放军陆军第八十集团军医院全军创伤骨科研究所，潍坊 261021
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摘要
目的 通过显微镜视下对第1、2足趾甲床滋养血管的解剖学研究，实现手指端甲床缺损的精准移植修复。 方法 自2012年1月至2022年3月，我们根据26例趾及第2足趾间微观血管解剖研究结果及趾背动脉弓分3型的特点，设计足趾甲床组织瓣精准移植方式，实施112例手指端甲床缺损的精准移植修复手术。 结果 所有患指甲床修复术后均成活。术后所有患者均获得随访，时间为3个月至9年，平均23.6个月，甲床色泽红润、质地坚韧，皮瓣两点分辨觉达4～7 mm，甲床长度(12.1±2.2) mm。按中华医学会手外科学会上肢部分功能评定试用标准评定：优81例，良26例，可4例，差1例，优良率达95.54%。 结论 基于最佳供区微观血管解剖的足趾甲床复合组织瓣精准移植手术是手指端甲床缺损获得逼真恢复的关键。 Objective To achieve precise transplantation and repair of fingertip nail bed defects, through anatomical research on the nutrient vessels of the first and second toe nail beds under a microscope. Methods From January 2012 to March 2022, based on the microanatomical results of vessels between the great toe and the second toe in 26 cases, as well as the characteristics of the three types of great toe dorsal artery arch, we designed a precise transplantation method for the tissue flap of the toe nail bed and performed precise transplantation and repair surgery on 112 cases of finger nail bed defects. Results All affected fingers survived after repair surgery. All patients were follow-up for a period of 3 months to 9 years, with an average of 23.6 months. The nail bed was ruddy in color and tough in texture, with a two-point discrimination of 4 to 7 mm for the flap and a nail bed length of (12.1±2.2) mm. According to the trial criteria for evaluating the upper limb function issued by Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 81 cases, good in 26 cases, fair in 4 cases, poor in 1case. The excellent and good rate reached 95.54%. Conclusion The precise transplantation of toe nail bed composite tissue flap based on the optimal vascular microanatomy of the donor site is the key to achieving realistic restoration of finger nail bed defects.
Abstract
Objective To achieve precise transplantation and repair of fingertip nail bed defects, through anatomical research on the nutrient vessels of the first and second toe nail beds under a microscope. Methods From January 2012 to March 2022, based on the microanatomical results of vessels between the great toe and the second toe in 26 cases, as well as the characteristics of the three types of great toe dorsal artery arch, we designed a precise transplantation method for the tissue flap of the toe nail bed and performed precise transplantation and repair surgery on 112 cases of finger nail bed defects. Results All affected fingers survived after repair surgery. All patients were follow-up for a period of 3 months to 9 years, with an average of 23.6 months. The nail bed was ruddy in color and tough in texture, with a two-point discrimination of 4 to 7 mm for the flap and a nail bed length of (12.1±2.2) mm. According to the trial criteria for evaluating the upper limb function issued by Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 81 cases, good in 26 cases, fair in 4 cases, poor in 1case. The excellent and good rate reached 95.54%. Conclusion The precise transplantation of toe nail bed composite tissue flap based on the optimal vascular microanatomy of the donor site is the key to achieving realistic restoration of finger nail bed defects.
关键词
指损伤/移植/精准外科/微观解剖学
Key words
Hand injuries/Transplantation/Precision surgery/Microanatomy
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