利用指轴型复合组织瓣修复拇指多指畸形.doc

利用指轴型复合组织瓣修复拇指多指畸形[摘要]目的：总结利用指轴型复合组织瓣修复拇指多指畸形的手术方法。方法：从形态、大小近似的两拇指远端至两指分叉处设计切口线，去除两指相邻的各半侧皮肤软组织及一侧拇指的指骨、肌腱，保留另一侧拇指的指骨、肌腱，利用两指相离部分所形成的复合组织瓣，相互对合包绕指骨、肌腱，完成拇指多指畸形的修复。结果：所有复合组织瓣全部成活，拇指形态、功能得到了良好的修复。结论：利用指轴型复合组织瓣对部分拇指多指畸形的修复是一种可供选择、效果较好手术方法。 [关键词]拇指多指畸形；轴型复合组织瓣 [中图分类号]R622[文献标识码]A[文章编号]1008-6455（2008）03-03 Repairing of thumb duplication with axial pattern complex tissue flap SONG Bao-qiang, HAN Yan, XIA Wen-sen,YANG Li,LI Yong, SHU Mao-guo, PAN Yong, CAI Yan-li (Department of Plastic Surgery, Xijing Hospital, the Fourth Military Medical University. Xi’an 710032, China) Abstract：ObjectiveTo summarize surgical ways to repair thumb duplication by axial pattern complex tissue flap of thumb. Methods The incision line was designed from the far-end to the joint of two balanced and symmetrical thumbs. Adjacent Half side of skin parenchyma of two thumbs and phalange and tendon of unilateral thumb were excised while phalange and tendon of the other side were reserved. The axial complex tissue flaps which formed from the remaining lateral portions of two thumbs were connected with each other to cover the reserved phalange and tendon.ResultsAll complex tissue flaps survive, shape and function of thumbs are repaired well. ConclusionSome thumb duplication could be repaired by axial pattern complex tissue flap of thumb, it is an alternative and preferably effective surgical way. Key words: thumb duplication; axial pattern complex tissue flap 先天性拇指多指畸形是最常见的多指畸形[1-2]，由于拇指在手功能、形态中的特殊作用，对拇指多指畸形进行功能和形态的双重修复有着重要的意义[3]。我们利用指轴型复合组织瓣对19例拇指多指畸形进行了修复，取得了较好的效果，现将有关手术方法介绍如下。 1临床资料 先天性拇指多指畸形患者19例，其中男性12例，女性7例，年龄4个月～18岁，平均年龄2.5岁，其中单侧拇指多指畸形15例，双侧拇指多指畸形4例。按Wassel分类[4]，3例为Wassel I型，7例Wassel II型，5例为Wassel III型，4例为Wassel IV型。16例单侧拇指多指畸形中，畸形的拇指呈分叉状或轻度蟹足样，两拇指大小、形态较为相近。3例双侧拇指多指畸形中均有一只手的两畸形拇指明显不对称，另一只手两畸形拇指较为对称。对于明显不对称的拇指畸形我们采用了保留主干指，切除赘生指后直接缝合的方法，不在本文的总结范围内。因而本文总例数为19例，其中右手11例，左手8例。 2手术方法 2.1手术设计：根据外观形态及X片指骨特征，选其中一侧形态、位置更接近正常的拇指作为保留指（以该指位于尺侧为例）。该指除桡侧半（与桡侧指拇指相邻的部分）指甲、甲床、皮肤软