Component Separation of Left 2nd Toe Free Flaps for Two Finger Defects

組織分離性左腳第二指重建兩手指缺損

林志鴻(Chih-Hung Lin) ； 林有德(Yu-Te Lin)

《臺灣整形外科醫學會雜誌》 22卷2期 (2013/06) Pp. 168-174

摘要

背景：手指掌面組織缺損最好是以帶知覺的指球性皮膚來重建，腳趾與手指具有最近似的組織能供應具知覺穩定與耐磨擦的指（趾）球構造。手指壓碎傷常見是多指的組織缺損或斷指，且需重建手術。目的及目標：當斷指計劃以腳趾移植重建，而另一指之缺陷卻局部組織不適宜時，又腳趾球性組織確是較佳的選項。為減少腳的供應區傷害，單一左腳第二趾可設計出兩組動靜脈系統，成為兩個游離瓣以重建兩指的缺陷。材料及方法：第二腳趾血液供應來自脛骨側的腳趾動脈和足背動脈，或腓骨側的腳趾動脈。可就此解剖設計出游離瓣以重建兩指的缺陷。藉此提出兩個案例的報告，一為腳趾瓣及近位腳趾關節瓣重建第四指遠位缺損及第三指近位手指關節炎，另一例為腳趾瓣及腳趾趾球知覺皮瓣重建第三指遠位缺損及第二指指球缺損。結果：兩個案例經顯微移植手術及術後復健過程順利。分別經8年和11年追蹤，且均獲得知覺及活動功能的結果。結論：左腳第二趾可設計出兩組動靜脈系統，成為兩個游離瓣以重建兩指的缺陷。可免除第二個供應區的摘取，達到左腳第二趾的充分運用及一次性的功能重建。

並列摘要

Background:Sensate glabrous skin flap is usually the best option for the finger volar side defect reconstruction. Toe flap possess the similar character of stable, sensate, and durable skin for the finger resurfacing. Multiple digital trauma may be indicated for toe transfer and toe flap reconstruction.Aim and Objectives:2nd toe comprises to vascular supply system which allow the 2nd toe can be split into two flaps. In case that toe transfer is justified for the lost finger, and the local flap for finger is not feasible, economical usage of one 2nd toe can provide two flaps for two digits reconstruction simultaneously.Materials and Methods:2nd toe got the circulation from two arterial inflow, one from tibial side plantar digital artery and dorsalis pedis artery, and the other from fibular side plantar digital artery. Two cases of multiple digital crush injuries underwent distal toe for 2 fingers reconstructions, and accompanying one proximal interphalangeal joint and pulp flap from toe for another finger defect reconstructions.Results:Both hands presented functional active motion restoration and sensory outcome, 6-8mm 2 point discrimination, in a one stage reconstruction after 8 and 11 years follow up.Conclusion:Meticulous component separation of left 2nd toe based on its two arterial supply, two flaps can be created for different finger reconstructions. Thus the patient can get rid of another donor site harvesting and accomplish a functional restoration in one stage procedure.

並列關鍵字

toe transfer ； toe flap