手指Ⅳ～Ⅵ度缺损的全形再造孙文海王增涛仇申强目的介绍手指Ⅳ～Ⅵ度缺损的全形再造方法。方法自1998年12月至2010年12月，对手指Ⅳ度缺损63例85指,Ⅴ度缺损31例49指，Ⅵ度缺损17例23指进行了手指全形再造。保留4个足趾的，（足母）甲瓣供区用2趾甲皮瓣修复；保留5个足趾的，（足母）甲瓣供区用皮瓣移位或移植来修复，第2足趾关节供区取髂骨充填。手指Ⅳ度缺损和部分Ⅴ度缺损，采用（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣，串1条髂骨再串第2趾近侧趾间关节的方法再造。部分近节指骨缺失长度较长的Ⅴ度缺损手指，采用（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣，串l条髂骨，再串第2趾近侧趾间关节，最后还要在近节指骨残端与移植的第2趾近侧趾间关节间再串l条髂骨的方法再造。Ⅵ度缺损的手指，采用以下顺序串连：（足母）趾腓背侧骨、趾甲、皮肤复合组织瓣，串l条髂骨，串第2趾近侧趾间关节重建手指近指间关节，串l条髂骨重建近节指骨，串第2跖趾关节重建掌指关节的方法再造。结果再造手指157指全部成活。平均随访7个月～11年，其中75指行二期整形手术。再造手指外形美观，再造指指腹两点辨别觉为5～12mm。67指行术后肌腱松解手术，再造指间关节活动度：伸-10°～10°，屈55°～100°，平均81°。结论手指Ⅳ度至Ⅵ度缺损全形再造，再造的手指兼具美观外形与良好运动功能，缺点是手术较复杂。指；再造；（足母）甲瓣;显微外科FullreconstructionofⅣtoⅥ-degreefingerdefectSUNWen-haiWANGZeng-taoQIUShen-qiangDepartmentofHandandFootSurgery,ProvincialHospitalAffiliatedofShandongUniversity,Jinan250021,ChinaObjectiveTointroducetheclinicalapplicationoffullreconstructionfor72casesofⅣtoⅥ-degreefingerdefect.MethodsFromDecember1998toDecember2010,sixty-threecases(85fingets)ofⅣ-degreefingerdefect,thirty-threecases(49fingers)ofⅤ-degreefingerdefectand17cases(23fingers)withⅥ-degreefingerdefectwereappliedfullreconstruction.TheproceduresoffullreconstructionofⅣtoⅤ-degreefingerdefectwereasfollows:Harvestpartofnail,skinwhichincludessomeskinharvestedfromdorsalandpalmarmetatarsaltoensurethelengthofthereconstructedfinger,anddorsalpartofdistalphalanxfromhalluxtoformacompositeflap,whichconstitutethecontourofafinger,andharvestinginterphaalangealjointfromthesecondtoestoreconstructtheproximalinterphalangeal(PIP)joint.Bonetransplantationfromtheiliacbonetothedistal(forⅣ-degreeandlightⅤ-degreedefect)orbothproximalanddistal(forsevereⅤ-degreedefect)stumpofthereconstructedPIPjointwasneededtogettoanappropriatelength.OnthebasisofthetreatmentofⅤ-degreedefect,reconstructionofⅥ-degreefingerdefectwastoharvestonemorejoint:themetatarsophalangealjointofthesecondtoe,andconnectitwiththeproximaliliacbonerod.ResultsAbouthalfofthecaseswereconservedof4toes,andthedonorwoundofhalluxeswerecoveredwiththecompositeflaps(composedofnail,skin)harvestedfromthesecondtoeswhichhadbeensacrificed.Theothercaseswereconservedofallthe5toes,andthedonorwoundofhalluxeswerecoveredbyfreeflaptransplantation.Thesecondtoeswerereconstitutedbybonetransplantationfromtheiliacbones.Allofthe157fingerssurvivedcompletely,and75fingersunderwentsecond-stageplasticsurgeries.Sixty-sevenfingersunderwentsecond-stagetenolysissurgeries.Follow-ups7monthsto11yearsaftersurgery,andallthereconstructedfingershadrealisticconfigurations,andthetwo-pointdiscriminationofthefingerpulpsrangesfrom5mmto12mm.DorsalextensionofthePIPjointswere-10°～10°,flexionofthePIPjointsrangefrom55°to85°,andtheaveragewas76°.ConclusionThefullreconstructionisanidealalterationforⅣtoⅥ-degreefingerdefectreconstructionfortherealisticconfigurationandidealfunctionofthereconstructedfingers....
