观察趾增宽术应用于缺损手指全形再造术后供受区外观、功能的远期效果。

选择2020年9月至2023年5月山东第一医科大学附属山东省立医院手足外科一期行趾增宽术，二期从增宽的趾切取甲骨皮瓣游离移植行缺损手指再造术患者共12例(14指)。其中男5例(5指)，女7例(9指)。二期手术前，供区趾行X线片检查，测量增宽趾的趾甲宽度和末节趾骨甲粗隆宽度。一期趾增宽术与二期手指全形再造术平均间隔11.4(7~17)个月。二期手指全形再造术后平均随访10.8(6~26)个月，观察再造手指成活情况及手指和趾的外观、功能。

一期趾增宽术后，趾甲平均增宽1.4(0.9~1.8)cm，增宽比例平均为82.8%(52.9%~114.3%)；末节趾骨甲粗隆平均增宽1.5(1.0~2.1)cm，增宽比例平均为131.9%(83.3%~190.9%)。二期手指全形再造术后，12例(14指)手指全部完全成活，均未发生血管危象。远期随访，再造的手指外观、功能近似健指，趾供区趾甲宽度接近正常，趾外观饱满，行走等功能无明显异常。

趾增宽术用于缺损手指全形再造，在满足再造手指外观、功能近似正常手指的前提下，还可使趾的外观和功能不受影响。

To observe the long-term effects of great toe widening surgery on postoperative appearance and function of the donor and recipient areas in the full-shaped reconstruction of defective fingers.

From September 2020 to May 2023, a total of 12 patients (14 fingers), including 5 males (5 fingers) and 7 females (9 fingers) in Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University were involved. The patients were performed great toe widening surgery in the first stage, and free lateral hallux osteo-onychocutaneous flaps from the widened toe for finger reconstruction in the second stage. Before the second stage surgery, X-ray examination of the donor site′s great toe was conducted to measure the width of the widened toe nail and the width of the distal phalanx nail tuberosity. The average interval between the first stage great toe widening surgery and the second stage finger reconstruction surgery was 11.4(7-17)months. The average follow-up period after the second stage finger reconstruction was 10.8(6-26)months. The survival of the reconstructed fingers, and the appearance and function of the fingers and great toes were observed.

After the first stage great toe widening surgery, the average width of the toenails was increased by 1.4(0.9-1.8)cm, with an average widening ratio of 82.8%(52.9%-114.3%). The average widening of the distal phalanx nail tuberosity was 1.5(1.0-2.1)cm, with an average widening ratio of 131.9%(83.3%-190.9%). After the second stage finger reconstruction surgery, all reconstructed fingers survived completely, and did not experience vascular crisis. Long term follow-up showed that the appearance and function of the reconstructed fingers were similar to those of healthy fingers, and the width of the toenails in the donor area was close to normal. The appearance of the great toe was plump, and there were no significant abnormalities in walking and other functions.

The great toe widening surgery used for full-shaped finger reconstruction, can ensure that the appearance and function of the reconstructed fingers are similar to those of normal fingers, without affecting the appearance and function of the great toe.