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find Keyword "踇甲皮瓣" 6 results
  • ANALYSIS OF THE CAUSES OF NECROSIS OF RETAINED FLAP ON TIBIAL SIDE AFTER TRANSPLANTATION OF THE GREAT TOE NAIL FLAP

    OBJECTIVE In order to investigate the causes of necrosis of the retained flap after transplantation of the great nail flap, according to the principle of plastic surgery, the following operation was designed. METHODS A tongue-shaped great toe flap was made with its base on the tibial side of the great toe and the width of the base was 1 cm to 1.5 cm. The flap contained the supporting vessels and nerves and the periosteum was also preserved. RESULTS From June 1982 to November 1997, the flap was used to repair 267 case, 277 fingers defects. After operation, the retained flap on the tibial side developed necrosis in 13 sides, an incidence of 4.69%, and in 78 sides, there was necrosis on the grafted skin on the donor site, an incidence of 28.7%. Most of the wounds healed after changing dressing, while 37 wounds healed from another skin graft. Of these cases, 178 cases had been followed up for 5 months to 16 years. It was found that the retained tibial tongue-shaped flap showed hyperplasia which extended to the weightbearing area of metatarso-phalangeal of great toe. It showed that the taking off of great toe nail flap according to first dorsal metatarsal artery (FDMA) I, II or III type, the incidence of development of necrosis of retained flap on tibial side showed no significant difference (P gt; 0.05). CONCLUSION It was believed that the necrosis of the retained flap was not related to the FDMA classification but had relation with the design, operative technique and presence of infection.

    Release date:2016-09-01 11:04 Export PDF Favorites Scan
  • 踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例

    目的总结应用踇甲皮瓣再造拇指及腓动脉穿支皮瓣游离移植修复足部供区的手术方法及临床效果。方法2016 年 6 月—2018 年 5 月,应用踇甲皮瓣联合腓动脉穿支皮瓣游离移植再造拇指并修复足部供区 15 例。男 10 例,女 5 例;年龄 21~48 岁,平均 34.6 岁。致伤原因:重物压砸伤 7 例,机器绞伤 5 例,电锯切割伤 3 例。Ⅰ度缺损 9 例,Ⅱ度缺损 6 例。入院至皮瓣手术时间 4~7 d,平均 5.2 d。结果术后踇甲皮瓣及腓动脉穿支皮瓣全部成活,切口均Ⅰ期愈合。患者均获随访,随访时间 8~24 个月,平均 16.4 个月。末次随访时,再造拇指指甲生长平整,有光泽,指腹饱满;足部皮瓣外形良好,颜色及质地接近受区。根据中华医学会手外科学会拇手指再造功能评定标准,获优 9 例、良 6 例;根据 Maryland 足功能评分标准,获优 10 例、良 5 例。患者行走步态正常,无跛行及疼痛不适。结论踇甲皮瓣修复拇指Ⅰ、Ⅱ度缺损,再造拇指可获得良好外观及功能;腓动脉穿支皮瓣具有血供可靠、血管恒定、易切取等优点,可有效修复足部供区。

    Release date:2020-06-15 02:43 Export PDF Favorites Scan
  • 携带跖背动脉皮瓣的长条形踇甲皮瓣修复手指套状缺损

    目的总结携带跖背动脉皮瓣的长条形踇甲皮瓣修复手指套状缺损的疗效。方法2016 年 8 月—2019 年 5 月,收治 8 例(8 指)机器压伤导致的手指套状缺损患者。男 5 例,女 3 例;年龄 18~45 岁,平均 28 岁。拇指 2 例、示指 4 例、中指 2 例;中节中段以远缺损 5 例、近节远段以远缺损 3 例。受伤至入院时间 45 min~3 h,平均 1.5 h。切取携带跖背动脉皮瓣的长条形踇甲皮瓣,折叠后以瓦合形式修复伤指创面;供区部分创面植皮修复后拉拢缝合。结果术后受区组织瓣及供区植皮均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间 6~18 个月,平均 12 个月。受区组织瓣色泽、弹性、外观接近正常手指,指甲生长良好。指腹感觉达 S3 6 例、S4 2 例;两点辨别觉为 6~10 mm,平均 8 mm。供区保留了足趾长度及饱满度,步态无异常。结论携带跖背动脉皮瓣的长条形踇甲皮瓣可有效恢复伤指功能和外形,减少对踇趾的损伤,是修复手指套状缺损的一种理想方法。

    Release date:2020-07-27 07:36 Export PDF Favorites Scan
  • Y-P形踇甲皮瓣修复手指指腹合并甲床缺损

    目的总结 Y-P 形踇甲皮瓣修复手指指腹合并甲床缺损的疗效。方法2018 年 1 月—2019 年 8 月,收治 12 例(12 指)外伤致手指指腹合并甲床缺损患者。男 7 例,女 5 例;年龄 22~46 岁,平均 37 岁。拇指 2 例、示指 5 例、中指 3 例、环指 2 例。指腹缺损范围 1.5 cm×1.5 cm~2.0 cm×1.8 cm;甲床缺损均位于甲根以远,骨质及肌腱存留良好。受伤至入院时间 40 min~2 h,平均 1.5 h。术中切取携带趾腹皮瓣的 Y 形踇甲皮瓣并缝合为 P 形皮瓣后修复指腹及甲床缺损。供区创面直接拉拢缝合。结果术后踇甲皮瓣均顺利成活,创面均Ⅰ期愈合。供区切口均Ⅰ期愈合。患者均获随访,随访时间 6~18 个月,平均 12 个月。除 2 例指腹略臃肿外,其余患者指腹外形良好、质地佳;患者指腹均恢复部分指纹,指甲生长良好。末次随访时皮瓣两点辨别觉为 6~11 mm,平均 8 mm。供区切口无明显瘢痕且较隐蔽。结论Y-P 形踇甲皮瓣能充分利用足趾皮肤,有效增加皮瓣面积同时供区能直接缝合,是修复指腹及甲床缺损的较好方法。

    Release date:2021-02-24 05:33 Export PDF Favorites Scan
  • 游离髂腹股沟皮瓣修复踇甲皮瓣供区

    目的探讨游离髂腹股沟皮瓣修复踇甲皮瓣供区的疗效。方法2017 年 1 月—2018 年 12 月,收治 12 例手指软组织缺损患者。男 10 例,女 2 例;年龄 27~50 岁,平均 36.8 岁。损伤指别:拇指 8 例,示指 3 例,中指 1 例。手指软组织缺损范围为 2.5 cm×1.6 cm~5.0 cm×3.5 cm。4 例合并骨缺损。受伤至入院时间为 2~9 h,平均 4.9 h。术中切取大小为 3.0 cm×2.0 cm~6.0 cm×4.5 cm 的踇甲皮瓣修复手指缺损后,以旋髂浅动脉为血管蒂的游离髂腹股沟皮瓣接力修复供区创面,皮瓣切取范围为 4.0 cm×3.0 cm~7.0 cm×5.0 cm。游离髂腹股沟皮瓣供区直接拉拢缝合。结果手术时间 300~500 min,平均 353.3 min。除 1 例游离髂腹股沟皮瓣术后出现血管危象,经对症处理后成活外,其余皮瓣均顺利成活。供区切口均Ⅰ期愈合。患者均获随访,随访时间 3~18 个月,平均 9 个月。游离髂腹股沟皮瓣质地、颜色与周围皮肤相似,随访期间无破溃发生。患者对足部外观及功能均满意。结论游离髂腹股沟皮瓣供区隐蔽、损伤小,是修复踇甲皮瓣供区的可选方案之一。

    Release date:2021-04-27 09:12 Export PDF Favorites Scan
  • Application of wrap-around great toe flap combined with medial plantar artery perforator flap for completely degloved fingers

    Objective To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Methods Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. Results All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.

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