大鱼际桡侧逆行岛状瓣修复拇指软组织缺损的临床研究
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摘要
目的探讨带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指软组织缺损的效果。
方法2001年～2008年,共修复拇指末节软组织缺损71例。分别应用腹部皮瓣12例、食指背侧岛状皮瓣16例、拇指桡背侧皮瓣15例、大鱼际桡侧逆行岛状瓣13例、游离趾腹皮瓣15例修复缺损。大鱼际桡侧逆行岛状瓣应用13例中,男10例,女3例；年龄22～51岁,平均32.4岁。伤因：电锯伤4例,电刨伤4例,挤压伤3例,切割伤2例。6例为指腹缺损；5例为指端缺损。皮瓣设计在大鱼际区桡侧,以桡侧指动脉为蒂,在指间关节近侧转位。皮瓣面积最大4.1×2.8cm,最小2.2×1.5cm,10例行皮神经与指神经吻合。术后10天开始功能锻炼。71例全部进行随访,随访内容包括拇指的色泽、外形、质地、出汗情况及综合感觉,拇指指腹痛觉、触觉、两点辨别觉及运动功能等。71例患者通过手术时间、术中出血量及综合感觉进行比较。
结果71例皮瓣全部成活。食指背侧皮瓣平均手术时间38min,出血20ml；拇指桡背侧皮瓣平均手术时间45min,术中出血25ml；拇桡侧大鱼际肌皮瓣平均手术时间42min,出血29ml；腹部皮瓣平均手术时间39min,出血80ml；游离趾腹皮瓣平均手术时间300min,出血165ml。游离趾腹皮瓣的手术时间、出血量与其他4种方法比较有显著差异。术后随访12～18个月,平均15个月。以最后一次复查为准,食指背侧皮瓣综合质地的优良率62.5%；拇指桡背侧皮瓣的优良率80%；拇桡侧大鱼际肌皮瓣的优良率84.6%；腹部皮瓣的优良率25%；游离趾腹皮瓣的优良率86.7%。大鱼际桡侧逆行岛状皮瓣修复后的皮肤色泽、外形、质地、出汗及综合质地感觉均优于腹部皮瓣及食指背侧皮瓣,与拇指桡背侧皮瓣、趾腹游离皮瓣优良率相似。
结论应用带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指软组织缺损,操作简单,血供可靠,能恢复感觉,修复后功能及外形均满意。
Objective:Objective To explore the effect of greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect
Methods:from 2001 to 2008,71 cases distal thumb sofe tissue defect was repared:Abdominal flap 12 cases The index finger dorsal island flap 16 cases, thumb at palmar side island flap15 cases,, greeter thenar palmar reversed island flapl3cases,the big toe skin flap 15 cases 13 cases was used to greeter thenar palmar reversed island flap male10 case, femal 3case, Aged 22 to 51 years old, mean age 32.4 years Injury due to Saw 4 cases, planer in 4 cases,3 cases of crush injury, cuts 2.6 cases of pulp defect; 5 with fingertip defect The flap was devised at the greater thenar with pedicle of thumb radialpalmar artery.The rotation point was proximal to the interphalangeal joint..The flap ranged from4.1×2.8cm to 2.2x 1.5cm connecting neurocutaneous and finger nerve for 10 cases.and summarized after ten days the results of 71 patients whose data were completely acquired,according to the shapes,sweating sensory and motor functions etc.71 patients, by operative time, blood loss and comprehensive sense to compare
Results:71 patients with flaps all survived. Index finger dorsal flap mean operative time 38min, bleeding 20ml; thumb dorsal radial flap mean operative time was 45min, blood loss was 25ml; thumb radial thenar flap mean operative time was 42min, bleeding 29ml; abdominal flap average operative time 39min, bleeding 80ml; free toe pulp flap mean operative time was 300min, bleeding 165ml. thenar palmar reversed island flap operation time, blood loss compared with the other four kinds of methods were significantly different. Were followed up for 12 to 18 months, an average of 15 months. Subject to final review, the index finger the fine texture of dorsal skin flap rate of consolidated 62.5%; thumb dorsal radial flap of the superior rate of 80%; thumb radial thenar flap fine rate was 84.6%; abdominal flap 25% good; free toe flap of excellent and good rate was 86.7%, The shapes,sweating and sensory of the thumb pulp with greeter thenar palmar reversed island flap were excellent to Abdominal flap The index finger dorsal island flap, and similar to thumb at ulnar side island flap, greeter thenar palmar reversed island flap,the big toe skin flap
Conclusion:The greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect has advantages of simple performance and reliable blood supply and reconstruct its sensation.
方法2001年～2008年,共修复拇指末节软组织缺损71例。分别应用腹部皮瓣12例、食指背侧岛状皮瓣16例、拇指桡背侧皮瓣15例、大鱼际桡侧逆行岛状瓣13例、游离趾腹皮瓣15例修复缺损。大鱼际桡侧逆行岛状瓣应用13例中,男10例,女3例；年龄22～51岁,平均32.4岁。伤因：电锯伤4例,电刨伤4例,挤压伤3例,切割伤2例。6例为指腹缺损；5例为指端缺损。皮瓣设计在大鱼际区桡侧,以桡侧指动脉为蒂,在指间关节近侧转位。皮瓣面积最大4.1×2.8cm,最小2.2×1.5cm,10例行皮神经与指神经吻合。术后10天开始功能锻炼。71例全部进行随访,随访内容包括拇指的色泽、外形、质地、出汗情况及综合感觉,拇指指腹痛觉、触觉、两点辨别觉及运动功能等。71例患者通过手术时间、术中出血量及综合感觉进行比较。
结果71例皮瓣全部成活。食指背侧皮瓣平均手术时间38min,出血20ml；拇指桡背侧皮瓣平均手术时间45min,术中出血25ml；拇桡侧大鱼际肌皮瓣平均手术时间42min,出血29ml；腹部皮瓣平均手术时间39min,出血80ml；游离趾腹皮瓣平均手术时间300min,出血165ml。游离趾腹皮瓣的手术时间、出血量与其他4种方法比较有显著差异。术后随访12～18个月,平均15个月。以最后一次复查为准,食指背侧皮瓣综合质地的优良率62.5%；拇指桡背侧皮瓣的优良率80%；拇桡侧大鱼际肌皮瓣的优良率84.6%；腹部皮瓣的优良率25%；游离趾腹皮瓣的优良率86.7%。大鱼际桡侧逆行岛状皮瓣修复后的皮肤色泽、外形、质地、出汗及综合质地感觉均优于腹部皮瓣及食指背侧皮瓣,与拇指桡背侧皮瓣、趾腹游离皮瓣优良率相似。
结论应用带血管神经蒂的大鱼际桡侧逆行岛状瓣修复拇指软组织缺损,操作简单,血供可靠,能恢复感觉,修复后功能及外形均满意。
Objective:Objective To explore the effect of greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect
Methods:from 2001 to 2008,71 cases distal thumb sofe tissue defect was repared:Abdominal flap 12 cases The index finger dorsal island flap 16 cases, thumb at palmar side island flap15 cases,, greeter thenar palmar reversed island flapl3cases,the big toe skin flap 15 cases 13 cases was used to greeter thenar palmar reversed island flap male10 case, femal 3case, Aged 22 to 51 years old, mean age 32.4 years Injury due to Saw 4 cases, planer in 4 cases,3 cases of crush injury, cuts 2.6 cases of pulp defect; 5 with fingertip defect The flap was devised at the greater thenar with pedicle of thumb radialpalmar artery.The rotation point was proximal to the interphalangeal joint..The flap ranged from4.1×2.8cm to 2.2x 1.5cm connecting neurocutaneous and finger nerve for 10 cases.and summarized after ten days the results of 71 patients whose data were completely acquired,according to the shapes,sweating sensory and motor functions etc.71 patients, by operative time, blood loss and comprehensive sense to compare
Results:71 patients with flaps all survived. Index finger dorsal flap mean operative time 38min, bleeding 20ml; thumb dorsal radial flap mean operative time was 45min, blood loss was 25ml; thumb radial thenar flap mean operative time was 42min, bleeding 29ml; abdominal flap average operative time 39min, bleeding 80ml; free toe pulp flap mean operative time was 300min, bleeding 165ml. thenar palmar reversed island flap operation time, blood loss compared with the other four kinds of methods were significantly different. Were followed up for 12 to 18 months, an average of 15 months. Subject to final review, the index finger the fine texture of dorsal skin flap rate of consolidated 62.5%; thumb dorsal radial flap of the superior rate of 80%; thumb radial thenar flap fine rate was 84.6%; abdominal flap 25% good; free toe flap of excellent and good rate was 86.7%, The shapes,sweating and sensory of the thumb pulp with greeter thenar palmar reversed island flap were excellent to Abdominal flap The index finger dorsal island flap, and similar to thumb at ulnar side island flap, greeter thenar palmar reversed island flap,the big toe skin flap
Conclusion:The greeter thenar palmar reversed island flap with neurovascular pedicle and minimal free flap in reparing of thumb soft tissue defect has advantages of simple performance and reliable blood supply and reconstruct its sensation.
引文
[1]关德宏,吕松芩,李贵东,等.拇指桡掌侧动脉为蒂的大鱼际逆行岛状皮瓣修复拇指指腹缺损.中华手外科杂志,2002,9：170-171.
[2]高士濂主编.实用解剖图谱四肢分册(上册).上海：上海科学技术出版社,2004.282-283.
[3]李晋,王江宁, 杨卫东,等.带血管神经蒂的大鱼际桡侧皮瓣修复拇指指腹缺损.中华手外科杂志,2002,12：223-225.
[4]侯书健,程国良,方光荣,等.急诊修复拇指指腹缺损三种方法的研究.中华手外科杂志,2002,9：153-154.
1王澍寰.手部创伤的修复[M].北京：北京出版社.1997,37、38；435～471
2顾玉东.手的修复与再造[M].上海：上海医科大学出版社.1995,70～112
3刘建祥.外伤性拇指缺损重建的治疗进展中医正骨.2007,70-72
4 Serafin D. Atlas of microswrgical compositetissue t ransplantation.1st ed. Philadelphia:W.B. Saunders Company,1996.592.
5王澍寰.手部创伤的修复.第1版.北京：北京出版社,1997.430.
6张涤生.显微修复外科学.第1版.北京：人民卫生出版社,1985.255.
7程国良.手指再植与再造.第1版.北京：人民卫生出版社,1997.238
8蔡佩琴.拇指截指分类法专题讨论会的学术意义.中华骨科杂志.2000,319-320.
9 Brunelli GA, Brunnelli GR. Reconstruction of traumaticabsence of the thumb in the adult by pollcization [J]. Hand Clin,1992,8:141-145.
10 Cobb TK, Stocks GW, May WF, et al. Thumb reconstructi-on by metacarpal lengthening after traumatic loss at the level of the interphalangeal joint[J]. Orthop Rev,1990,19:47.
11 Foucher G, Merle M, Maneaud M,et al.Microsurgical free partialtoe transfer in hand reconstruction:a report of 12 cases. PlastReconstr Surg,1980,65(5):616.
12谭海涛,林源,梁裔鸿等1改良拇甲瓣加第二足趾移植延迟性手再造1中华手外科杂志,2000,16(2)：97
13周礼荣,蔡仁祥,王伟等1拇背甲皮瓣移植联合带指神经血管蒂岛状皮瓣移位再造拇指中华手外科杂志,1999,15(2)：76
14程国良,方光荣,潘达德,等.不同程度拇、手指缺损采用不同形式的足趾组织移植再造与修复.中华手外科杂志,1995,11(4)：200.
15冯亚高,洪光祥.保留拇趾全长的游离拇甲瓣再造拇指九例.中华显微外科杂志,2006,29(3)：205.
16 Woo SH, Lee GJ, Kim KC, et al. Immediate partial great toetransfer for the reconstruction of composite defects of the distalthumb. Plast Reconstr Surg, 2006,117(6):1906.
17屈志刚,方光荣,程国良,等.拇指、手指Ⅰ、Ⅱ度缺损的再造[J].中华骨科 杂志,2002,22(7)：386-389.
18程国良.不同形式的足趾移植拇手指再造与修复[J].中华显微外科杂志,2002,25(1)：8-9.
19 Lee KS, Park JW, Chung WK. Thumb reconst ruction witha wrap-around f ree flap according to the level of the ampu2tation [J]. J Hand Surg (Am),2000,25 (4):644-650.
20李少华,于仲嘉,何鹤皋,等.拇甲瓣与第二跖趾骨、关节和肌腱的复合移植再造拇指[J].中华手外科杂志,1994,10(4)：198-201.
21 Koshima 1, Kawada S, Etoh H, et al. Free combined thinwrap-around flap with a second toe proximal interphal-angeal joint transfer for reconstruction of the thumb [J]. Plast Reconstr Surg,1995,96:1205-1210
22侯明钟,黄燮青,贾万新,等冷冻异体手指复合组织移植的临床评价[J].中国修复重建外科,2000,14：245-248.
23 ei FC, Chen HC, Chuang DC, et al. Aesthetic refinements intoe-to-hand transfer surgery. Plast Reconstruct Surg,1996,98:485.
24方光荣,丁小珩,屈志刚,等.改良跖趾关节屈曲方向的第二足趾移植再造拇手指.中华显微外科杂志,2004,27(4)：241
25康庆林,张春才,许硕贵.足趾移植再造部分手指若干技术问题探讨.中国矫形外科杂志,2003,11(1)：18.
26王炜,杨志贤,戴传昌,等.足趾移植拇指再造的美学原理及拇指缺损分类.组织工程与重建外科杂志,2005,1(3)：123.
27王增涛,蔡锦方,曹学成,等.拇趾腓侧皮瓣嵌入第二足趾改形法再造拇手指.中华手外科杂志,2002,1：18.
28王金昌,赵炳显,刘健伟,等.第一掌背动脉筋膜皮瓣改善第二足趾再造拇指术后的外形.中华手外科杂志,2006,22(5)：299.
29王文德,李宗宝,姚保兵,等.第二足趾跖侧菱形皮瓣转移改形法再造拇指.中华手外科杂志,2006,22(5)：294.
30赵建强,焦晓虎,刘梁,等.拇指残端残余皮瓣镶嵌入第二趾改形再造拇指.实用手外科杂志,2004,18(3)：167.
31 Woo SH, Lee GJ,Kim KC,et al.Cosmetic reconstruction of distalfinger absence with partial second toe transfer.J Plast ReconstrAesthet Surg,2006,59(4):317.
32滕国栋,袁光海,程国良,等.趾移植手指再造术后趾腹皮瓣局部转移的整形.中华显微外科杂志,2005,28(4)：362.
33李忠,劳克诚,张成进,等.趾侧方皮瓣嵌入足趾跖侧再造手指.中华手外科杂志,2006,22(6)：380.
34 Vitkus K. Aesthetic reconstruction of long fingers with toe-to-hand transfer. J Reconstr Microsurg,1988,4(5):369.
35张高孟,顾玉东,张丽银,等.手指全长缺损的长指再造.手外科杂志,1992,8：241.
36程国良,方光荣,候书健,等.双足第二趾节段桥接移植再造手指一例.中华手外科杂志,1999,15：71.
37王增涛,蔡锦方,曹学成,等.拇趾腓侧皮瓣嵌入第二足趾改形法再造拇手指.中华手外科杂志,2002,1：18.
38芮永军,施海峰,邱扬,等.部分拇甲瓣和第二趾腹皮瓣联合修复指脱套伤.中华显微外科杂志,2005,28(4)：295.
39郭翱,张功林,徐招跃,等.指甲延长术在第二足趾移植再造拇手指中的应用.中华手外科杂志,2006,22(6)：362
40于仲嘉,黄玉池.拇趾皮甲瓣和第二、三足趾联合移植再造拇、手指58例报告[J].实用手外科杂志,2001,15(2)：73-75.
41侯明钟,黄燮青,贾万新,等.自体第二足趾与异体手指复合组织移植[J].中华显微外科杂志,2002,25(4)：255-257
42 Jeng SF,W eiFC. The di st al 1 y based for ear m i sl and f 1 ap i n hand r econ-st r uct i on[J]. PI astR econst rSur g,1998,102 (2):400-406
43胡春松,邓雪峰,叶永秀,等.带旋髂浅血管的髂骨皮瓣修复拇指缺损[J].实用手外科杂志,2003,17(4)：226～227
44陈克俊,费起礼,戚伟.伤残食指移位再造拇指[J].中国修复重建外科杂志,1999,13(4)：237、238
45 D ubem ar d JM,O ven E,H er zber g G,etal. H um an hand al 1 o gr af t:r epor ton f i r st6 m ont hs[J]. Lancet,1999,353:1315-1320
46杜昭,黄德征.合并手部皮肤缺损的拇手指再造[J].中华显微外科杂志,2002,25(2)：140-141.
47侯书健,程国良,潘达德,等.吻合血管的游离皮瓣与第二足趾组合移植再造 拇指[J].中华显微外科杂志,1997,20(3)：227-229.
48 Li ui iR.A n open pr oposM f or clini calcom positeti ssue all ot ranspl ant a-t i on[J]. Tr anspl antPr oc,1998,30:2692-2696
49 Sawada S,Suzuk G,K awase Y,et al. N ovel I m m unosuppr essi ve agentFK 506 invitroefect sonthecl oned Tcel 1 act i va-don [J]. J I m m uno11987, 139:1791-1803
50侯明钟,黄燮青,贾万新,等.冷冻异体手指复合组织移植的临床评价[J].中国修复重建外科杂志,2000,14(4)：245～248
51 r anem ar k PI,Br ei ne U,Li ndst r om J,et al. I nt r aosseous anchor age ofdent alpr ot hesi s.1 Exper i m ent alst udi es [J]. Scand PI astR econst r Sur g,1969,3:81-100
52 A del 1Lekhol m U,R ocki erB,etal. A15-yearst udy ofsseoi nt egr at edi m-pl ant s i n t he t r eat m ent s of t he edent ul ous j aw [J]. I nt J O r al Sur g,1981,10:387-416
53 Joseph Schat zker,M D,Bsc(M ed),FR CSC. O sseoi nt egr at i on of m et al [J].Can JSur g,1995,38 (1):49-54
54 Li sgar t en M A. JD entR es[J]. JH and Sur g,1992,11 (2):364-365Br anem ar k PI,Br anem ar k R,Skal ak, etal. An at om y ofO s seoi nt egr at i onand t he Tr ansf erofLO ad.I n R. J. Fonseca andW. H.D avi s.R econst r uc-t i on Pr epr ost het i c O r aland M axi 11 of a-ci alSur ger y [M].2d ed. O r 1 ando:Saunder s, 1994
55 El ofEr i ksson,M. D.,Per-I ngvar Br anem ar k,M. D. O sseoi nt egr at i on f r omt he Per spect i ve oft he PI ast i c Sur geon [J]. PI astR econst rSur g,1994,93(3):626-637
56 M anur angsee P,I sar i yawutC,Chat ut hong V,etal. O sseoi nt e. gr at ed f i n-ger pr ost hesi s:A n al t er nat i ve m et hod f or f i nger r e-const r uct i on [J]. JH and Sur g,2000,25 (1):86、92
57 M anur angsee P,I sar i yawutC,Chat ut hong V,etal. O sseoi nt e. gr at ed f i n-ger pr ost hesi s:A n al t er nat i ve m et hod f or f i nger r e-const r uct i on [J]. JH and Sur g,2000,25 (1):86、92
58 Lundbor g G,Br anem ar k PI,R osen B. O sseoi nt egr at ed t hum bpr ost he-ses:a concept f or f i xat i on of di gi t pr ost het i c devi ces [J]. J H and Sur g, 1996,21(2):216、221
59 eitmann C,Levin,LS. Alternatives to thumb replantation (J). Plast Re2constr Surg,2002,110(6):149221503.
60李文庆,王利宫,云霞.五种皮瓣修复拇指软组织缺损的疗效分析(J).中华骨科杂志,2004,24(8)：477.
61侯书健,程国良,方光荣,等.急诊修复拇指指腹缺损三种方法的研究(J).中华手外科杂志,2002,18(3)：1532154
62 Strickland JW,Kleinman WB. Thumb reconstruction (M).3rd ed, New York: Churchill Livingstone,1993:426.
63 Thompson JS. Reconstruction of the insensate thumb by neurovascularisland transfer (J). Hand Clin,1992,8(1):992105.
64 Brunelli GA,Brunelli GR. Reconstruction of traumatic absence of thethumb in the adult by pollicization (J). Hand Clin,1992,8(1):41255.
65 Ishida O,Taniguchi Y,Sunagawa T,et al. Pollicization of the index fin2ger for traumatic thumb amputation (J). Plast Reconstr Surg,2006,117(3):9092914.
66侯书健,程国良,方光荣,等.手部复合组织缺损的显微外科修复[J].中华显微外科杂志,2003,26(1)：9-11
67高俊,王建国,董建峰,等.带足外侧、足背皮瓣的第二趾移植再造Ⅴ、 Ⅵ区拇指缺损[J].中华手外科杂志,2004,20(1)：50
68鹿泽兵,王炳秀,台中惠.第二趾甲背皮瓣修复拇指背侧皮肤缺损[J].中华显微外科杂志,2004,27(1)：54-55
69 Ejeskar A, Dahlgren A, Friden J.Cl inical and radiographic evaluation ofsurgical recons truction of finger flexion in tetraplegia.J Hand Surg [Am]2005; 30(4): 842-849
70顾玉东,吴敏明,郑忆柳.第二足趾移植术中血管的变异及处理(J).中华外科杂志,1985,23(4)：31
71 Wei FC Ch,Chuang CC. Reconstruction of thumb with a trimmed greattoe transfer technique (J). Plast Reconstr Surg,1988,82 (5):506.
72 Chung KC,Wei FC. An outcome study of thumb reconstruction usingmicrovascular toe transfer (J). J Hand Surg, (Am),2000,25(4):651-658.
73程国良.足趾组织移植拇手指再造与修复的进展(J).实用手外科杂志,2004,18(3)：131.
74 Steichen JB,Weiss AP. Reconstruction of traumatic absence of thethumb by microvascular free tissue transfer from the foot (J). HandClin,1992,8(1): 17232.
75 Wei FC Ch,Chuang CC. Reconstruction of thumb with a trimmed greattoe transfer technique (J). Plast Reconstr Surg,1988,82 (5):506.
[2]高士濂主编.实用解剖图谱四肢分册(上册).上海：上海科学技术出版社,2004.282-283.
[3]李晋,王江宁, 杨卫东,等.带血管神经蒂的大鱼际桡侧皮瓣修复拇指指腹缺损.中华手外科杂志,2002,12：223-225.
[4]侯书健,程国良,方光荣,等.急诊修复拇指指腹缺损三种方法的研究.中华手外科杂志,2002,9：153-154.
1王澍寰.手部创伤的修复[M].北京：北京出版社.1997,37、38；435～471
2顾玉东.手的修复与再造[M].上海：上海医科大学出版社.1995,70～112
3刘建祥.外伤性拇指缺损重建的治疗进展中医正骨.2007,70-72
4 Serafin D. Atlas of microswrgical compositetissue t ransplantation.1st ed. Philadelphia:W.B. Saunders Company,1996.592.
5王澍寰.手部创伤的修复.第1版.北京：北京出版社,1997.430.
6张涤生.显微修复外科学.第1版.北京：人民卫生出版社,1985.255.
7程国良.手指再植与再造.第1版.北京：人民卫生出版社,1997.238
8蔡佩琴.拇指截指分类法专题讨论会的学术意义.中华骨科杂志.2000,319-320.
9 Brunelli GA, Brunnelli GR. Reconstruction of traumaticabsence of the thumb in the adult by pollcization [J]. Hand Clin,1992,8:141-145.
10 Cobb TK, Stocks GW, May WF, et al. Thumb reconstructi-on by metacarpal lengthening after traumatic loss at the level of the interphalangeal joint[J]. Orthop Rev,1990,19:47.
11 Foucher G, Merle M, Maneaud M,et al.Microsurgical free partialtoe transfer in hand reconstruction:a report of 12 cases. PlastReconstr Surg,1980,65(5):616.
12谭海涛,林源,梁裔鸿等1改良拇甲瓣加第二足趾移植延迟性手再造1中华手外科杂志,2000,16(2)：97
13周礼荣,蔡仁祥,王伟等1拇背甲皮瓣移植联合带指神经血管蒂岛状皮瓣移位再造拇指中华手外科杂志,1999,15(2)：76
14程国良,方光荣,潘达德,等.不同程度拇、手指缺损采用不同形式的足趾组织移植再造与修复.中华手外科杂志,1995,11(4)：200.
15冯亚高,洪光祥.保留拇趾全长的游离拇甲瓣再造拇指九例.中华显微外科杂志,2006,29(3)：205.
16 Woo SH, Lee GJ, Kim KC, et al. Immediate partial great toetransfer for the reconstruction of composite defects of the distalthumb. Plast Reconstr Surg, 2006,117(6):1906.
17屈志刚,方光荣,程国良,等.拇指、手指Ⅰ、Ⅱ度缺损的再造[J].中华骨科 杂志,2002,22(7)：386-389.
18程国良.不同形式的足趾移植拇手指再造与修复[J].中华显微外科杂志,2002,25(1)：8-9.
19 Lee KS, Park JW, Chung WK. Thumb reconst ruction witha wrap-around f ree flap according to the level of the ampu2tation [J]. J Hand Surg (Am),2000,25 (4):644-650.
20李少华,于仲嘉,何鹤皋,等.拇甲瓣与第二跖趾骨、关节和肌腱的复合移植再造拇指[J].中华手外科杂志,1994,10(4)：198-201.
21 Koshima 1, Kawada S, Etoh H, et al. Free combined thinwrap-around flap with a second toe proximal interphal-angeal joint transfer for reconstruction of the thumb [J]. Plast Reconstr Surg,1995,96:1205-1210
22侯明钟,黄燮青,贾万新,等冷冻异体手指复合组织移植的临床评价[J].中国修复重建外科,2000,14：245-248.
23 ei FC, Chen HC, Chuang DC, et al. Aesthetic refinements intoe-to-hand transfer surgery. Plast Reconstruct Surg,1996,98:485.
24方光荣,丁小珩,屈志刚,等.改良跖趾关节屈曲方向的第二足趾移植再造拇手指.中华显微外科杂志,2004,27(4)：241
25康庆林,张春才,许硕贵.足趾移植再造部分手指若干技术问题探讨.中国矫形外科杂志,2003,11(1)：18.
26王炜,杨志贤,戴传昌,等.足趾移植拇指再造的美学原理及拇指缺损分类.组织工程与重建外科杂志,2005,1(3)：123.
27王增涛,蔡锦方,曹学成,等.拇趾腓侧皮瓣嵌入第二足趾改形法再造拇手指.中华手外科杂志,2002,1：18.
28王金昌,赵炳显,刘健伟,等.第一掌背动脉筋膜皮瓣改善第二足趾再造拇指术后的外形.中华手外科杂志,2006,22(5)：299.
29王文德,李宗宝,姚保兵,等.第二足趾跖侧菱形皮瓣转移改形法再造拇指.中华手外科杂志,2006,22(5)：294.
30赵建强,焦晓虎,刘梁,等.拇指残端残余皮瓣镶嵌入第二趾改形再造拇指.实用手外科杂志,2004,18(3)：167.
31 Woo SH, Lee GJ,Kim KC,et al.Cosmetic reconstruction of distalfinger absence with partial second toe transfer.J Plast ReconstrAesthet Surg,2006,59(4):317.
32滕国栋,袁光海,程国良,等.趾移植手指再造术后趾腹皮瓣局部转移的整形.中华显微外科杂志,2005,28(4)：362.
33李忠,劳克诚,张成进,等.趾侧方皮瓣嵌入足趾跖侧再造手指.中华手外科杂志,2006,22(6)：380.
34 Vitkus K. Aesthetic reconstruction of long fingers with toe-to-hand transfer. J Reconstr Microsurg,1988,4(5):369.
35张高孟,顾玉东,张丽银,等.手指全长缺损的长指再造.手外科杂志,1992,8：241.
36程国良,方光荣,候书健,等.双足第二趾节段桥接移植再造手指一例.中华手外科杂志,1999,15：71.
37王增涛,蔡锦方,曹学成,等.拇趾腓侧皮瓣嵌入第二足趾改形法再造拇手指.中华手外科杂志,2002,1：18.
38芮永军,施海峰,邱扬,等.部分拇甲瓣和第二趾腹皮瓣联合修复指脱套伤.中华显微外科杂志,2005,28(4)：295.
39郭翱,张功林,徐招跃,等.指甲延长术在第二足趾移植再造拇手指中的应用.中华手外科杂志,2006,22(6)：362
40于仲嘉,黄玉池.拇趾皮甲瓣和第二、三足趾联合移植再造拇、手指58例报告[J].实用手外科杂志,2001,15(2)：73-75.
41侯明钟,黄燮青,贾万新,等.自体第二足趾与异体手指复合组织移植[J].中华显微外科杂志,2002,25(4)：255-257
42 Jeng SF,W eiFC. The di st al 1 y based for ear m i sl and f 1 ap i n hand r econ-st r uct i on[J]. PI astR econst rSur g,1998,102 (2):400-406
43胡春松,邓雪峰,叶永秀,等.带旋髂浅血管的髂骨皮瓣修复拇指缺损[J].实用手外科杂志,2003,17(4)：226～227
44陈克俊,费起礼,戚伟.伤残食指移位再造拇指[J].中国修复重建外科杂志,1999,13(4)：237、238
45 D ubem ar d JM,O ven E,H er zber g G,etal. H um an hand al 1 o gr af t:r epor ton f i r st6 m ont hs[J]. Lancet,1999,353:1315-1320
46杜昭,黄德征.合并手部皮肤缺损的拇手指再造[J].中华显微外科杂志,2002,25(2)：140-141.
47侯书健,程国良,潘达德,等.吻合血管的游离皮瓣与第二足趾组合移植再造 拇指[J].中华显微外科杂志,1997,20(3)：227-229.
48 Li ui iR.A n open pr oposM f or clini calcom positeti ssue all ot ranspl ant a-t i on[J]. Tr anspl antPr oc,1998,30:2692-2696
49 Sawada S,Suzuk G,K awase Y,et al. N ovel I m m unosuppr essi ve agentFK 506 invitroefect sonthecl oned Tcel 1 act i va-don [J]. J I m m uno11987, 139:1791-1803
50侯明钟,黄燮青,贾万新,等.冷冻异体手指复合组织移植的临床评价[J].中国修复重建外科杂志,2000,14(4)：245～248
51 r anem ar k PI,Br ei ne U,Li ndst r om J,et al. I nt r aosseous anchor age ofdent alpr ot hesi s.1 Exper i m ent alst udi es [J]. Scand PI astR econst r Sur g,1969,3:81-100
52 A del 1Lekhol m U,R ocki erB,etal. A15-yearst udy ofsseoi nt egr at edi m-pl ant s i n t he t r eat m ent s of t he edent ul ous j aw [J]. I nt J O r al Sur g,1981,10:387-416
53 Joseph Schat zker,M D,Bsc(M ed),FR CSC. O sseoi nt egr at i on of m et al [J].Can JSur g,1995,38 (1):49-54
54 Li sgar t en M A. JD entR es[J]. JH and Sur g,1992,11 (2):364-365Br anem ar k PI,Br anem ar k R,Skal ak, etal. An at om y ofO s seoi nt egr at i onand t he Tr ansf erofLO ad.I n R. J. Fonseca andW. H.D avi s.R econst r uc-t i on Pr epr ost het i c O r aland M axi 11 of a-ci alSur ger y [M].2d ed. O r 1 ando:Saunder s, 1994
55 El ofEr i ksson,M. D.,Per-I ngvar Br anem ar k,M. D. O sseoi nt egr at i on f r omt he Per spect i ve oft he PI ast i c Sur geon [J]. PI astR econst rSur g,1994,93(3):626-637
56 M anur angsee P,I sar i yawutC,Chat ut hong V,etal. O sseoi nt e. gr at ed f i n-ger pr ost hesi s:A n al t er nat i ve m et hod f or f i nger r e-const r uct i on [J]. JH and Sur g,2000,25 (1):86、92
57 M anur angsee P,I sar i yawutC,Chat ut hong V,etal. O sseoi nt e. gr at ed f i n-ger pr ost hesi s:A n al t er nat i ve m et hod f or f i nger r e-const r uct i on [J]. JH and Sur g,2000,25 (1):86、92
58 Lundbor g G,Br anem ar k PI,R osen B. O sseoi nt egr at ed t hum bpr ost he-ses:a concept f or f i xat i on of di gi t pr ost het i c devi ces [J]. J H and Sur g, 1996,21(2):216、221
59 eitmann C,Levin,LS. Alternatives to thumb replantation (J). Plast Re2constr Surg,2002,110(6):149221503.
60李文庆,王利宫,云霞.五种皮瓣修复拇指软组织缺损的疗效分析(J).中华骨科杂志,2004,24(8)：477.
61侯书健,程国良,方光荣,等.急诊修复拇指指腹缺损三种方法的研究(J).中华手外科杂志,2002,18(3)：1532154
62 Strickland JW,Kleinman WB. Thumb reconstruction (M).3rd ed, New York: Churchill Livingstone,1993:426.
63 Thompson JS. Reconstruction of the insensate thumb by neurovascularisland transfer (J). Hand Clin,1992,8(1):992105.
64 Brunelli GA,Brunelli GR. Reconstruction of traumatic absence of thethumb in the adult by pollicization (J). Hand Clin,1992,8(1):41255.
65 Ishida O,Taniguchi Y,Sunagawa T,et al. Pollicization of the index fin2ger for traumatic thumb amputation (J). Plast Reconstr Surg,2006,117(3):9092914.
66侯书健,程国良,方光荣,等.手部复合组织缺损的显微外科修复[J].中华显微外科杂志,2003,26(1)：9-11
67高俊,王建国,董建峰,等.带足外侧、足背皮瓣的第二趾移植再造Ⅴ、 Ⅵ区拇指缺损[J].中华手外科杂志,2004,20(1)：50
68鹿泽兵,王炳秀,台中惠.第二趾甲背皮瓣修复拇指背侧皮肤缺损[J].中华显微外科杂志,2004,27(1)：54-55
69 Ejeskar A, Dahlgren A, Friden J.Cl inical and radiographic evaluation ofsurgical recons truction of finger flexion in tetraplegia.J Hand Surg [Am]2005; 30(4): 842-849
70顾玉东,吴敏明,郑忆柳.第二足趾移植术中血管的变异及处理(J).中华外科杂志,1985,23(4)：31
71 Wei FC Ch,Chuang CC. Reconstruction of thumb with a trimmed greattoe transfer technique (J). Plast Reconstr Surg,1988,82 (5):506.
72 Chung KC,Wei FC. An outcome study of thumb reconstruction usingmicrovascular toe transfer (J). J Hand Surg, (Am),2000,25(4):651-658.
73程国良.足趾组织移植拇手指再造与修复的进展(J).实用手外科杂志,2004,18(3)：131.
74 Steichen JB,Weiss AP. Reconstruction of traumatic absence of thethumb by microvascular free tissue transfer from the foot (J). HandClin,1992,8(1): 17232.
75 Wei FC Ch,Chuang CC. Reconstruction of thumb with a trimmed greattoe transfer technique (J). Plast Reconstr Surg,1988,82 (5):506.