双足趾与第2趾甲皮瓣联合一期修复多手指脱套伤.DOCVIP

临床医学论文-双足趾与第2趾甲皮瓣联合一期修复多手指脱套伤 ?????????????作者：张全荣，芮永军，施海峰，陆征峰，张辉，寿奎水 【摘要】? [目的]探讨双足趾腓侧皮瓣与第2趾甲皮瓣瓦合修复多个手指脱套伤的临床应用。[方法]采用多种不同手术方法修复多个手指脱套伤，双足部分甲瓣和第2趾胫侧皮瓣修复手指3例6指。双足第2趾甲瓣和趾腓侧皮瓣修复手指17例37指。双足部分甲瓣和双足第2趾甲瓣加股前外侧皮瓣修复手指1例4指。[结果]21例47指98块皮瓣，其中有一块皮瓣坏死，97块皮瓣全部成活，随访17例37指，随访时间6～9个月，平均8个月。36指指间关节活动均接近正常，33指指甲生长完好，外形接近正常，手指两点辨别觉5～11 mm，供区功能基本无影响。[结论]双足趾腓侧皮瓣(或部分趾甲瓣)与第2趾甲瓣(或第2趾胫侧皮瓣)一期组合瓦合修复是多个手指脱套伤较好的选择。 【关键词】? 多指损伤; 组织移植; 显微外科手术 　　Abstract：[Objective]To inrestigate the clinical outcomes of using bilateral tibial flap of the second toe nail flap combined with the fibulal flap of the big toe to repair the multifinger degloving injury.[Method]A variety of different methods were used to repair the multifinger degloving injury,six fingers in 3 cases were repaired by partial bilateral wraparound flaps combined with the tibial flap of the second toe.Sixteen fingers in 8 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe.Six fingers in 2 cases were repaired by bilateral second toenail flap,the fibulal flap of the big toe and the digital arterial island flap.Three fingers in l case were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe and the the lateral flap of dorsum of foot.Six fingers in 3 cases were repaired by bilateral second toe nail flap and the fibulal flap of the big toe and bilateral dorsum flap of foot.Four fingers in 1 case were repaired by partial bilateral wraparound flaps and the tibial flap of the second toe and the anterolateral thigh flap.Six fingers in 3 cases were repaired by bilateral second toe nail flap combined with the fibulal flap of the big toe,and bilateral dorsum flap of foot and bilateral anterolateral thigh flap.[Result]Ninetyseven flaps of 98 flaps of 47 fingers in 21 cases were suvived well,with 1 flap developed necrosis.The followup duration ranged from 6 months to 9 years in 17 cases (37 fingers).In addition to the activities of DIP limited,the other interphalan