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目的 探讨一期移植不同形式的(足母)甲皮瓣和穿支皮瓣,进行拇手指再造并修复足部供区的手术指征、技术和疗效.方法 自2012年2月至2015年10月,根据59例患者拇手指缺损的指别、数量和分度以及伴有的手部皮肤软组织缺损范围,设计多种与(足母)甲皮瓣同一血管蒂的足部复合组织瓣和游离穿支皮瓣,再造拇手指的同时修复足部供区继发性缺损.本组共再造91指,其中单个拇指Ⅰ度9例9指、Ⅱ度23例24指、Ⅲ度5例5指;含拇指的两个手指5例12指、三个手指2例6指、四个手指2例8指;不含拇指的单个手指5例5指、两个手指2例4指、三个手指6例18指.足部继发性缺损均用游离穿支皮瓣(45例)或嵌合型穿支骨皮瓣重建(14例).结果 术后再造指全部存活,足部皮瓣部分坏死3例,完全坏死1例.随访时间为2～21个月,平均11个月.根据中华医学会手外科学会拇手指再造功能评定标准:优42例,良17例.根据Maryland足功能评分标准:优46例,良13例.结论 本术式在尽可能减小足部和肢体供区损伤的前提下,不仅能再造出外观和功能兼优的拇手指,而且还为解决套脱性手外伤需多指再造的难题提供了新的选择.“,”Objective To explore the surgical indications,techniques and treatment outcomes of toe-tofinger transfer and donor foot reconstruction with different types of big toe wrap-around flap and perforator flap.Methods From February 2012 to October 2015,59 cases of thumb or finger defects were treated.Based on the digit involved,the number of digits involved and the level of the defects,a variety of dorsalis pedis composite flaps and perforator flaps were designed and combined with wrap-around flap from the big toe to reconstruct the missing finger or thumb and cover the donor sites.There were a total of 91 digits that were reconstructed,among which single Ⅰ degree defect of 9 thumbs in 9 cases,Ⅱ degree defect of 24 thumbs in 23 cases,Ⅲ degree defect of 5 thumbs in 5 cases,thumb defect with two fingers involvement of 12 fingers in 5 cases,thumb defect with three fingers involvement of 6 fingers in 2 cases,thumb defect with four fingers involvement of 8 fingers in 2 cases,single finger defect of 5 fingers in 5 cases,two finger involvement in 4 fingers in 2 cases,and three finger involvement in 18 fingers in 6 cases.Donor site defect in the foot was repaired with perforator flap (45 cases) or chimeric superficial circumflex iliac artery perforator osteocutaneous flap (14 cases).Results All the reconstructed fingers and thumbs survived.Flaps used to cover donor site of the foot survived except partial necrosis in 3 cases and complete necrosis in 1 case.The follow-up period ranged from 2 to 21 months,being 11 months on average.According to the evaluation criteria for finger/thumb reconstruction issued by the Hand Surgery Society of the Chinese Medicine Association,the results were rated as excellent in 42 cases and good in 17 cases.Function of the donor foot was rated as excellent in 46 cases and good in 13 cases based on the Maryland foot function scoring system.Conclusion The above described procedures take advantage of perforator flaps that minimize morbidity in the donor site while affording excellent reconstruction of fingers and thumbs.These procedures provide a new treatment option for degloving hand injury that requires multiple finger reconstruction.