连续双翼皮瓣成形指蹼一期分离短指并指畸形的灵活应用  

Multiple digit symbrachydactyly web space reconstruction using dorsal contiguous gullwing flaps

作　　者：田晓菲[1] 肖军[1] 李天武[1] Tian Xiaofei;Xiao Jun;Li Tianwu(Department of Burn and Plastic Surgery,Ministry of Education Key Laboratory of Child Development and Disorders,National Clinical Research Center for Child Health and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,Children’s Hospital of Chongqing Medical University,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院烧伤整形外科,儿童发育疾病研究教育部重点实验室,国家儿童健康与疾病临床医学研究中心,儿童发育重大疾病国家国际科技合作基地,儿科学重庆市重点实验室,重庆400014

出　　处：《中华整形外科杂志》2022年第12期1350-1357,共8页Chinese Journal of Plastic Surgery

摘　　要：目的探讨灵活应用改良的连续双翼皮瓣成形指蹼修复3个及以上手指并连的短指并指畸形的安全性及临床效果。方法回顾性分析2018年1月至2021年1月重庆医科大学附属儿童医院收治的3个及以上手指并连的短指并指畸形患儿临床资料。设计背侧改良的连续双翼皮瓣,每个皮瓣远端之间不留间隙,结合锯齿状对偶皮瓣分离指体后,指蹼及指体的创面大部分可关闭,对于部分病例残余的少许皮肤缺损,取腕部掌尺侧全厚皮片植皮。2例患儿采用了改良设计和原设计的混合使用方案。统计术中血管情况、植皮情况、手术时间、术后手指血供以及伤口愈合等级;随访并采用改良Withey评分法评价术后效果。结果共纳入21例患儿,男13例,女8例,年龄6个月~6岁,平均20个月。其中,3指并指13例,4指并指8例,涉及50个指蹼,合并虎口狭窄或部分并连8例。其中19例患儿所有指蹼并连程度均大于或等于手指长度的一半,2例3指并连者有1个指蹼并连达手指一半长度。本组病例均在2 h内完成所有患指的分离;术中6个指蹼由于血管起始处偏浅,结扎了1侧血管,术后手指血运均正常;12个手指有小块植皮。术后无伤口感染、皮肤及植皮坏死发生。术后随访3~37个月,平均10个月。所有成形指蹼形态自然,掌指横纹水平的指蹼宽度均不小于该水平处手指根部宽度的1/3,与手掌、手指的比例协调;指蹼深度均能达到或略深于掌指横纹水平,手指长度相对于手掌大小仍显短小;均无继发性手指屈-伸活动障碍、侧偏及旋转畸形发生。术后外观均能被患儿家长接受,手腕供区瘢痕不明显。所有随访病例的改良Withey评分均为0分。结论改良连续双翼皮瓣可安全地同时分离多个手指的短指并指,可不需要植皮或者植皮面积很小,适用于并连皮肤较紧张的多个手指的短指并指畸形。对于3个指蹼的并连皮肤紧张度不一致的Objective To investigate the safety and effectiveness of modified contiguous gullwing flaps for web space reconstruction of multiple digit symbrachydactyly.Methods A retrospective analysis was performed on patients of multiple digit symbrachydactyly who underwent surgery in the Children’s Hospital of Chongqing Medical University from January 2018 to January 2021.The modified dorsal contiguous gullwing flaps were designed to reconstruct the web space without leaving a gap between the distal ends of each flap.After separating the fused digits with a zigzag incision,most of the wounds could be closed directly.For a few cases of the skin defect,the skin grafts harvested from the palmer-ulnar site of the ipsilateral wrist was used to cover the wound.In 2 cases,the modified design and the original design were used in combination.Intraoperative findings of the digital proper arteries,skin grafts,operation time and the finger blood supply,and the postoperative data of wound healing grade were recorded.The results were followed up and evaluated by a modified Withey scale.Results A total of 21 patients were enrolled,including 13 males and 8 females,ranging in age from 6 months to 6 years old with an average age of 20 months.Among them,there were 13 cases of three-fingered syndactyly and 8 cases of four-fingered syndactyly,with a total of 50 webs.Among them,8 cases were combined with the first web stenosis or partial syndactyly.In 19 cases,the degree of syndactyly was at least the half length of fingers,and the remaining 2 cases had mild symptoms.All operations could be finished within 2 hours.During the operation,one side digital artery in 6 webspaces was ligatured owing to the bifurcation point was too distal,and the vascular perfusion was normal.Small pieces of skin grafts were used in 12 fingers,the wound healed in one stage with no wound infection,and skin graft necrosis occurred.After 3-37 months of follow-up(average of 10 months),the shape of the formed webspace was natural,and the width of the webspace at the leve

关 键 词：手畸形 先天性 先天性短指并指 POLAND综合征 连续双翼皮瓣 

分 类 号：R622[医药卫生—整形外科]