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跖背逆行筋膜蒂皮瓣修复 足母 趾皮肤缺损

目的 总结应用跖背逆行筋膜蒂皮瓣修复趾皮肤缺损的手术方法及疗效。 方法 2004 年9 月－2009 年5 月，收治足母 趾皮肤缺损8 例。男5 例，女3 例；年龄4 ～ 58 岁。撕脱伤6 例，重物砸伤2 例。缺损部位：近节趾骨残端皮肤缺损3 例，近节趾腹缺损4 例，末节趾腹缺损1 例。皮肤缺损范围为4.5 cm × 2.0 cm ～ 8.0 cm × 7.0 cm。受伤至入院时间1 ～ 12 h。术中切取大小为6 cm × 4 cm ～ 8 cm × 5 cm 跖背逆行筋膜蒂皮瓣修复缺损，其中2 例皮瓣不能完全覆盖受区者，采用中厚皮片在非负重区植皮闭合创面。供区直接缝合或游离植皮修复。 结果 术后皮瓣及植皮均成活，供受区切口Ⅰ期愈合。8 例均获随访，随访时间6 ～ 12 个月。皮瓣血运、质地、颜色与受区周围皮肤接近。患足能负重行走，无溃疡或磨损。 结论 跖背逆行筋膜蒂皮瓣是修复趾皮肤缺损的一种有效、简便、安全的方法。

急诊足母趾腓侧皮瓣嵌入塑形第2 足趾移植拇指再造

目的 总结在急诊第2 足趾移植拇指再造术中，应用趾腓侧皮瓣嵌入塑形的临床经验。 方法 1998 年1 月－ 2003 年1 月，急诊应用带趾腓侧皮瓣嵌入塑形的第2 足趾移植再造外伤性拇指缺损12 例，男9 例，女3 例；年龄23 ～ 45 岁。撕脱伤5 例，压砸伤7 例。缺损程度：Ⅲ度5 例，Ⅳ度1 例（清创后为Ⅴ度缺损），Ⅴ度6 例。伤后至手术时间2 ～ 7 h，平均5.4 h。术中切取趾腓侧皮瓣范围1.5 cm × 0.5 cm ～ 2.0 cm × 0.8 cm。趾腓侧供区直接缝合， 第2 足趾供区游离植皮覆盖。 结果 术后伤口及供区切口均Ⅰ期愈合。12 例再造拇指全部成活。随访2 年，再造拇指关节活动度为60 ～ 90°，平均74°；两点辨别觉为6 ～ 10 mm，平均8 mm。再造拇指功能、运动、外观均满意。 结 论 趾腓侧皮瓣嵌入塑形急诊第2 足趾移植再造拇指，具有操作简便、安全、经济的优点，外观良好，功能满意。

远端蒂足内侧皮瓣在儿童足母趾皮肤缺损中的应用

目的 总结应用远端蒂足内侧皮瓣逆向移位修复儿童足母趾皮肤缺损的临床效果。 方法 2003 年3 月－ 2007 年10 月，采用远端蒂足内侧皮瓣修复足母趾皮肤缺损7 例。男5 例，女2 例；年龄2 ～ 13 岁。撕脱伤4 例，重物砸伤3 例。足母趾末节趾腹缺损1 例，近节腹侧缺损4 例， 趾残端皮肤缺损2 例。软组织缺损范围为2.5 cm ×2.0 cm ～ 6.0 cm × 4.0 cm。病程2 h ～ 1 个月。术中切取皮瓣范围3.0 cm × 2.5 cm ～ 6.5 cm × 4.5 cm，供区中厚皮片植皮修复。 结 果 5 例皮瓣及供区植皮均成活；2 例皮瓣远端分别于术后2 d 和3 d 出现0.5 cm × 1.0 cm 水疱，均于2 周后脱痂皮愈合。供受区切口均Ⅰ期愈合。7 例均获随访，随访时间6 个月～ 4 年7 个月。皮瓣外观、血运、弹性好，两点辨别觉为5 ～ 12 mm，无溃疡或磨损，行走无影响。 结论 采用远端蒂足内侧皮瓣修复儿童足母趾皮肤缺损是一种较好的手术方法。

足母趾部分甲皱襞和甲床楔形切除治疗嵌甲

CLINICAL STUDY ON TREATMENT OF OBSTINATE INGROWN NAIL WITH DISTAL PHALANX OF GREAT TOE AND SOFT TISSUE ORTHOPAEDICS

Objective To investigate the clinical curative effect of distal phalanx of great toe and soft tissue orthopaedics for treatment of obstinateingrown nail. Methods From October 1997 to May 2006,31 patients(38 nails) suffering from obstinate ingrown nail were treated by the distal phalanx of great toe and soft tissue orthopaedics. There were 23 males(27 nails) and 8 females(11 nails) with an average age of 17.5 years(12-28 years). The disease course was 2years and 1 month to 14 years(average, 31-6 months). At the same time, thirty-eight patients with diseases of feet were selected randomly as controls. The depth of the nail groove was measured.The X-ray films were taken to calculate the rate of upward projection of tuberosity (r). Results Thedepth of the nail and r value of 31 patients were 2.87±0.31 mm and 0.149±0.013，respectively. There were statistically significant differences when compared with control group（1.06±0.10 mm and 0.060±0.019）（Plt;0.01）. Thirty patients(37 nails) had a primary healing; 1 patient(1 nail) had a delayed healing. Twenty-nine patients(36 nails) were followed up for 8 to 29 months(average, 21 months). The appearance of the nail was satisfactory. No relapse occurred in all patients. Conclusion The upward projection of tuberosity of distal phalanx of great toe and deepened nail groove are the most important anatomical causes for ingrown nail. The distal phalanx of great toe and soft tissue orthopaedics is aneffective treatment for obstinate ingrown nail.