【摘 要】
：
目的：探讨足拇趾趾端皮肤软组织缺损临床修复效果,拇趾趾端皮肤软组织缺损,若残端修整,势必造成足趾短缩,对足功能造成一定影响；应用传统带蒂皮瓣,风险较大.足背内侧皮神经营养血管皮瓣的应用为足趾软组织缺损的修复提供了一种选择,但由于旋转点的限制,皮瓣行程长,对足背损伤范围广,甚至较远端的足趾创面难以达到.方法：2010年9月至2014年5月,本科应用趾背筋膜蒂皮瓣逆行修复足趾远端皮肤软组织缺损9例足拇
【出 处】
：
第二届海峡两岸医药卫生交流协会骨科学术论坛暨四川省医学会第十八次骨科学术会议
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目的：探讨足拇趾趾端皮肤软组织缺损临床修复效果,拇趾趾端皮肤软组织缺损,若残端修整,势必造成足趾短缩,对足功能造成一定影响；应用传统带蒂皮瓣,风险较大.足背内侧皮神经营养血管皮瓣的应用为足趾软组织缺损的修复提供了一种选择,但由于旋转点的限制,皮瓣行程长,对足背损伤范围广,甚至较远端的足趾创面难以达到.方法：2010年9月至2014年5月,本科应用趾背筋膜蒂皮瓣逆行修复足趾远端皮肤软组织缺损9例足拇趾趾端皮肤软组织缺损修复进行研究,本组9例患者,包括男性6例,女性3例,年龄15-52±0.3岁,锐器切割伤4例,重物砸伤2例,交通伤2例,拇趾术后遗留创面1例,拇趾远端软组织缺损伴骨外露2例,均为新鲜创伤,受伤至入院时间平均5.2小时,趾端皮肤软组织缺损面积为2×2cm2-2.4×4cm2,拇趾甲皮瓣移植术后供区骨外露2例,面积大小为1.5×1.6cm2-1.5×2cm2.方法：本科应用趾背筋膜蒂皮瓣逆行修复足趾远端皮肤软组织缺损,受区准备：硬膜外麻醉成功后,先予创面彻底清创,本组病例创面缺损范围1.5×1.6cm2-2.5×4cm2.术中根据伤情与需要,于受区解剖出腓侧趾底神经,备用.皮瓣设计及切取；以拇趾背内侧缘趾背神经走行为皮瓣轴线,于近节趾背及以近设计皮瓣,皮瓣外侧缘一般不超过拇长伸肌腱,内侧缘不超过拇趾侧中线,皮瓣旋转点为拇趾趾间关节近端0.5cm,于肌腱腱膜浅层切取皮瓣,注意保持皮神经的连续完整性,皮瓣蒂部需携带宽1cm左右的筋膜组织.创面及供取修复；皮瓣切取完毕后,一般蒂部带有宽约0.5皮蒂,经明道逆行转移至受区,本组7例皮瓣,3例皮瓣将所携带趾背皮神经与受区腓侧趾底神经吻合,本组切取皮瓣面积1.6×1.9cm2-3×4.5cm2.皮瓣供区创面宽度在2cm以内者大多可直接拉拢缝合,超过此宽度以全层皮片打包植皮修复.术后观察要点：术后予以卧床1周并抬高患肢,可酌情应用扩血管药物,防止蒂部受压,如出现皮瓣肿胀、色紫、皮温低、甚至水疱形成,首先应考虑蒂部受压的可能,应予以松解敷料、拆除蒂部数针缝线,以解除压迫、恢复循环.结果：本组9例患者术后皮瓣均顺利成活,伤口Ⅰ期愈合,供区切口愈合良好！皮片全部成活,术后随访3-12个月,平均约6个月,皮瓣血运良好,质地柔软、耐磨、外形满意,患者感觉恢复良好.结论：逆行趾背筋膜蒂皮瓣能有效修复拇趾远端缺损,临床效果满意.
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