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摘要


背景:手指重建之目的在於改善手部功能與外觀,隨著顯微手術技術的進步,過去無法重建的手部殘缺,目前許多已可重建。目的及目標:在於檢視我們用足部組織來治療手指缺損的成效。材料及方法:我們收集了七位病患(五位男性兩位女性,平均年齡35歲),手部缺損機制包括壓輾傷五位病患、電燒傷一位病患以及接觸燒傷一位。重建方式包括一例以大腿前外側皮瓣併腳趾移植至手部;一例單純以腳趾移植至手部;一例以腳趾組織以包覆式移植至手部;一例以腳趾併足背自由肌腱皮瓣移植至手部;以及三例足部第一趾間自由皮瓣移植。結果:我們共完整追蹤到五位病患,追蹤時間平均2年9個月(範圍:10個月到5年6個月)。重建指主動活動度平均為119.5度(範圍:0到182度)。神經復元靜態兩點區辨能力平均為9.8毫米(範圍:7到14毫米)。此五位對於術後結果均相當滿意。一位病患由於重建的拇指僵硬無法進行動作所以結果較不理想。移植組織供應區的足部沒有重要病變。結論:藉著適當的病人選擇,足部可以提供相當良好的組織來源用以重建手部的功能與外觀。

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並列摘要


Background: Because of the anatomical similarities between the hand and the foot, various foot tissues can be transferred to the hand for reconstruction of digital defects. Aim and Objectives: To report the results of our patients after various foot tissue transfers to their digital defects. Materials and Methods: 7 patients (5 males and 2 females, with an average age of 35 years) presenting various hand defects resulting from different mechanisms (machine crush: 5, electric burn: 1, contact burn: 1) were studied. Reconstructive procedures included one anterolateral thigh (ALT) flap with subsequent toe-to-thumb transplantation at a second stage, one second toe-to-thumb transplantation, one second toe wrap-around to index transplantation, one second toe with concomitant harvest of a free tendinocutaneous flap from the same foot for simultaneous distal index and dorsum of the adjacent thumb, and three first web space free flap to various digits. Results: All surgeries were successfully done and 5 of the 7 patients were evaluated at an average of 2 years and 9 months follow up (range from 10 months to 5 years and 6 months). Total active motion averaged 119.5° (range from 0 to 182°) and sensory recovery measured with static two-point discrimination (2-PD) averaged 9.8 mm (range from 7 mm to 14 mm). One patient whose left neothumb reconstructed using right second toe lost its motor function and was stiff. Conclusion: With proper patient selection, the foot can provide good and reliable tissues for reconstruction of hand function and appearance.

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