摘要目的 探索肌皮瓣动力重建大鱼际缺损的手术方式,改进足底内侧肌皮瓣的设计和切取方法,更好地重建大鱼际缺损区的逼真外形和对掌功能.方法 自2010年11月至2012年1月,游离移植足内侧跨供区皮瓣联合(姆)展肌修复大鱼际缺损患者6例,重建创面和对掌功能,术后3周开始功能锻炼和康复理疗,6、12个月时对移植的肌肉行肌电图检查.结果 术后皮瓣及植皮均存活良好,外形饱满,具有类似大鱼际区掌、背双侧皮肤的外形及特点.随访12个月以上,采用中华医学会手外科学会上肢功能评价标准检测评定运动和感觉功能.术后6个月移植肌肉的肌电图最大收缩呈混合相,12个月呈干扰相.术后6个月皮瓣恢复痛、触觉；12个月两点分辨觉为7.5～11.2 mm,平均7.9mm,感觉为S3+.移植肌肉肌力恢复至M3 ～ M4.结论 改良足内侧跨区皮瓣联合(姆)展肌游离移植是一种新的肌皮瓣动力重建术式,皮瓣术后有良好的外形和痛触觉,移植的(姆)展肌获得神经再支配后具有收缩性,可以重建拇对掌功能.

abstractsObjective To explore the surgical technique of functional myocutaneous flap transfer for reconstruction of the appearance of the thenar eminence and thumb opposition,and to improve the design and harvest of medial pedis myocutaneous flap.Methods From November 2010 to January 2012,6 cases with skin and muscle defects of the thenar eminence were treated by modified medial pedis flap combined with abductor hallucis muscle transfer using microsurgical techniques.Functional exercises and physical therapy were initiated 3 weeks postoperatively.Electromyogram (EMG) of the thenar muscles was performed at 6 and 12 months after the transfer.Grip strength,pinch strength,British Medical Research Council (BMRC) muscle strength and sensory recovery grading were performed during the follow-up periods.Results Flaps in all cases survived well.The appearance of the flaps was similar to the normal skin of the hand.All cases had more than 12 months' followup.In all cases,voluntary abduction of the thumb by the transferred abductor hallucis was achieved and confirmed by EMG.EMG of the thenar muscles at 6 months showed a mixed pattern upon maximum voluntary contraction and an interference pattern at 12 months.Pain and touch perception returned at 6 months,while twopoint discrimination was 7.5 to 11.2 mm (mean,7.9 mm) at 12 months.BMRC sensory grading was S3+,while muscle power recovery was M3 to M4.Conclusion As a new myocutaneous flap,the modified medial pedis flap combined with abductor hallucis muscle transfer is effective for repairing thenar eminence defects.The flap had not only good appearance and sensory reinnervation,but also the transplanted hallucis abductor muscle results in satisfactory opposition function of the thumb once it is innervated.