足部瓦合皮瓣联合植骨再造不同程度拇指缺损的临床应用研究

发布时间：2018-07-02 12:08

本文选题：拇指 + 缺损　；参考：《苏州大学》2015年硕士论文

【摘要】：目的:探讨足部瓦合皮瓣联合植骨再造拇指的手术方法和临床疗效。方法:对14例拇指不同程度缺损的患者,采用足部瓦合皮瓣联合髂骨植骨再造。采用同蒂趾甲皮瓣与第二趾胫侧皮瓣瓦合再造拇指末节缺损5例,采用双蒂趾甲皮瓣与第二趾胫侧皮瓣瓦合再造拇指末节缺损4例,采用同蒂趾甲皮瓣与足背动脉皮瓣瓦合再造拇指近节缺损3例,采用双蒂趾甲皮瓣与足背动脉皮瓣瓦合再造拇指近节缺损2例。骨缺损均采用不带血供的髂骨条移植修复。结果:术后患者伤口均一期愈合,14例再造指均顺利成活。1例趾供区植皮部分坏死,经换药后愈合。术后8~12周摄X线片,移植骨与拇指骨质临床愈合取出内固定。随访6~60个月,修复后的拇指外形接近正常拇指,指甲生长良好,血供好,再造指体指背感觉恢复S2~S3,指腹感觉恢复S2~S4。8例保留掌指关节者,掌指关节活动度为0~70°,接近正常拇指掌指关节活动度,4例掌指关节、指间关节均保留者掌指关节活动正常,指间关节活动0~80°,接近正常。2例掌指关节融合者无关节活动度。14例均可以完成对指、对掌功能。随访期内未出现骨不愈合及移植骨吸收的现象。按照中华医学会拇、手指再造功能评价标准评定,属优者11例,良者3例。足部供区植皮愈合满意,无明显的瘢痕挛缩及破溃现象,不影响患者行走。髂部供区线状瘢痕愈合,无触痛等不适感。患者自我感觉均满意。结论:利用足部瓦合皮瓣联合植骨再造拇指可以恢复拇指的良好外形,供足足趾个数不减少,是一种较好的方法。
[Abstract]:Objective: to investigate the operative method and clinical effect of foot flap combined with bone graft for thumb reconstruction. Methods: 14 patients with different degree of thumb defect were treated with foot flap combined with iliac bone graft. Toe nail flap with the same pedicle and tibial flap with the second toe were used to reconstruct the distal segment of the thumb in 5 cases, and the tibial flap of the second toe and the double pedicle toenail flap were used to reconstruct the defect of the distal segment of the thumb in 4 cases. The proximal thumb defect was reconstructed with pedicle nail flap and dorsal foot artery flap in 3 cases and the proximal thumb defect with double pedicle toe nail flap and dorsal foot artery flap in 2 cases. Bone defects were repaired by iliac bone graft without blood supply. Results: all the patients had primary wound healing and 14 cases of finger reconstruction survived successfully. 1 cases had partial necrosis of skin grafts in toe donor area and healed after dressing change. X-ray films were taken at 812 weeks after operation and internal fixation was taken out after clinical healing of bone graft and thumb. Following up for 6 ~ 60 months, the repaired thumb was close to the normal thumb, the fingernail grew well, the blood supply was good, the dorsal sensation of the reconstructed finger recovered S2S3, and the ventral sensation of the finger recovered S2S4.8 cases of the metacarpophalangeal joint were preserved. The motion of metacarpophalangeal joint was 0 ~ 70 掳. The movement of metacarpophalangeal joint was close to that of normal thumb and metacarpophalangeal joint in 4 cases. The movement of interphalangeal joint was 80 掳, which was close to normal in 2 cases of metacarpophalangeal joint fusion. No bone nonunion and graft resorption occurred during the follow-up period. According to the evaluation standard of thumb and finger reconstruction function of Chinese Medical Association, 11 cases were excellent and 3 cases were good. The skin grafts in the donor area of the foot healed satisfactorily, without obvious scar contracture and rupture, and did not affect the walking of the patients. Iliac donor area linear scar healing, no tenderness and other discomfort. All the patients were satisfied with their self-feeling. Conclusion: it is a good method to restore the good appearance of the thumb by using the pedicle flap combined with bone graft, and the number of the donor toe is not reduced.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.3

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