目的

探讨改良静脉切取方式的足第二趾胫侧方皮瓣修复手指指端缺损的治疗效果。

方法

收集2020 年6 月至2023 年6 月于苏州瑞华骨科医院手外科采用改良静脉切取方式的足第二趾胫侧方皮瓣修复手指较小面积缺损18 例（18 指）患者病例资料，其中男12 例、女6 例；年龄22 ～56 岁，平均33 岁。 术中均行游离足第二趾胫侧皮瓣修复创面，皮瓣切取时采用改良静脉切取方式，皮瓣设计位于足第二趾胫侧方。 与传统术式相比，无需进行足背切口，切取趾胫侧方静脉或趾底静脉作为皮瓣的回流静脉，受区与指动脉及皮下静脉行端端吻合。 皮瓣切取面积1.5 cm×1.0 cm～2.5 cm×1.9 cm。 5 例皮瓣供区直接拉拢缝合，其余均行小腿游离植皮修复。 术后随访采用Michigan 手部功能问卷评定标准评定手功能恢复情况，采用总主动活动度（TAM）评估手指关节活动度的恢复情况。

结果

本组18 例（18 指）皮瓣全部成活，无血管危象发生。 术后随访6 个月～2 年，平均13 个月。 3 例皮瓣略臃肿，于术后3 个月行皮瓣修整术，其余皮瓣均未行整形手术。 皮瓣两点辨别觉12 ～14 mm。 足部供区及小腿切口均一期愈合，供区植皮均顺利成活，无挛缩、破溃，足部供区瘢痕较小，足部及小腿供区无明显功能障碍。 按照Michigan 手部功能问卷评定标准，11 例患者对手部外观非常满意，7 例表示满意。 手指活动度参照TAM 评定标准，优18 例。

结论

采用改良静脉切取方式的足第二趾胫侧方皮瓣修复手指指端缺损临床疗效较好，具有切取方便、足部损伤小、供区瘢痕小等优点。

Objective

To explore the therapeutic effect of repairing fingertip defects with a tibial flap of the second toe of the foot using an improved vein harvesting method.

Methods

From June 2020 to June 2023， 18 cases （18 fingers） of small-area finger defects in Department of Hand Surgery， Suzhou Ruihua Orthopedics Hospital were repaired using a lateral tibial flap of the second toe of the foot with an improved vein harvesting method.Among them， there were 12 males and 6 females， aged from 22 to 56 years， with an average age of 33 years.During the surgery， a free second toe tibial flap was used to repair the wound.The flap was harvested using a modified vein harvesting method， with the flap designed to be located on the lateral tibial side of the second toe of the foot.Compared to traditional surgical methods， there was no dorsal foot incision.The lateral or bottom vein of the toe was harvested as the return vein of the flap， and the recipient area was anastomosed end-to-end with the digital artery and subcutaneous vein.The harvested area of the skin flap was from 1.5 cm×1.0 cm to 2.5 cm×1.9 cm.5 cases of skin flap donor site were directly sutured， while the rest underwent free skin grafting from the lower leg.The postoperative follow-up was evaluated using the Michigan hand function questionnaire to assess the recovery of hand function， and total active motion （TAM） was used to evaluate the recovery of finger joint range of motion.

Results

All 18 skin flaps in this group survived without any vascular crisis.Postoperative follow-up ranged from 6 months to 2 years， with an average of 13 months.3 cases had slightly bloated skin flaps and underwent flap repair surgery three months after surgery， while the remaining skin flaps did not undergo plastic surgery.The two-point discrimination of the skin flap was from 12 to 14 mm.The incisions in the foot donor area and calf healed primarily， and the skin grafts in the donor area survived smoothly without contracture or ulceration.The scars in the foot donor area were small， and there were no significant functional impairments in the foot and calf donor areas.According to the Michigan hand function questionnaire evaluation criteria， 11 patients were very satisfied with the overall appearance of their hands， and 7 patients expressed satisfaction.According to the TAM evaluation criteria for finger mobility， 18 cases were rated as excellent.

Conclusion

The clinical efficacy of repairing finger tip defects with a lateral tibial skin flap of the second toe using an improved vein harvesting method is good， with advantages such as convenient harvesting， minimal foot injury， and small scar formation in the donor area.