中国修复重建外科杂志

中国修复重建外科杂志

双翼推进皮瓣成形指蹼治疗先天性并指畸形

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目的探讨应用双翼推进皮瓣成形指蹼治疗先天性并指畸形的临床疗效。方法2014 年 8 月—2017 年 8 月收治 30 例先天性并指畸形患儿,其中男 18 例,女 12 例;年龄 1.5~5 岁,平均 2.5 岁。双手并指畸形 8 例,单手并指畸形 22 例。共并指 39 个指蹼(其中中环小指并指 1 例);完全性并指 11 个指蹼,不完全并指 28 个指蹼。在并指根部背侧设计凸 V 形尖端、蒂部两侧带三角形皮肤的双翼皮瓣与掌侧锚形切口对应缝合,成形指蹼同时关闭指根部创面。并连的远端指体采用锯齿状皮瓣分离,侧方创面减脂后缝合,11 例指侧方较紧创面不能完全缝合者全厚皮片植皮修复。结果术后所有指蹼的双翼皮瓣均完全成活,无皮瓣坏死发生。远端指侧方植皮均成活,创面Ⅰ期愈合。30 例患儿均获随访,随访时间 6~12 个月,平均 9 个月。术后手指屈伸功能良好,指蹼深度、宽度正常。末次随访时根据 Swanson 等的手功能评定标准,对分指后的运动和感觉功能进行评定,获优 20 例、良 8 例、可 2 例,优良率达 93.3%。结论应用双翼推进皮瓣成形指蹼治疗先天性并指畸形能获良好临床疗效。

ObjectiveTo discuss the effectiveness of using dorsal two wing-shaped advancement flap to reconstruct finger web for treatment of congenital syndactyly.MethodsBetween August 2014 and August 2017, 30 cases of congenital syndactyly were treated, including 18 males and 12 females with an average age of 2.5 years (range, 1.5-5 years). Eight cases were of bilateral hands syndactyly and 22 cases of single hand syndactyly. There were 39 webs of syndactyly (including 1 case of syndactyly of middle finger, ring finger, and little finger). Among them, 11 webs were complete and 28 webs were incomplete. At the dorsum, a flap with V-shaped tip and two wing-shaped pedicle was designed and was just sewed up with an anchor-shaped incision at the palm. Distal end of fingers were separated by serrated flap and were sutured after removal of fatty tissue. In 11 cases with tight skin connection, the defect area at lateral and distal end of fingers was repaired by small pieces of full-thickness skin graft.ResultsAll the flaps survived completely after operation, and no flap necrosis occurred. The skin grafts on the distal side of the finger survived and the wound healed by first intension. All 30 cases were followed up 6-12 months, with an average of 9 months. Postoperative flexion and extension function of fingers were good, and the web depth and width were normal. At last follow-up, according to the Swanson et al. standard, 20 fingers were graded as excellent, 8 as good, and 2 as fair, with an excellent and good rate of 93.3%.ConclusionThe effectiveness of using dorsal two wing-shaped advancement flap to reconstruction finger web for treatment of congenital syndactyly is satisfactory.

关键词: 先天性并指畸形; 指蹼成形; 外科皮瓣

Key words: Congenital syndactyly; finger web reconstruction; surgical flaps

引用本文: 成德亮, 张丽君, 王强, 吕敏, 段虹昊, 胡雷鸣, 梁小菊. 双翼推进皮瓣成形指蹼治疗先天性并指畸形. 中国修复重建外科杂志, 2019, 33(2): 195-198. doi: 10.7507/1002-1892.201809012 复制

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