单纯性并指术后畸形的分类及手术治疗  

Classification and surgical treatment of postoperative deformity of simple syndactyly

作　　者：张生晖 肖军[1] 李天武[1] 袁心刚[1] 傅跃先[1] 邱林 田晓菲[1] Zhang Shenghui;Xiao Jun;Li Tianwu;Yuan Xingang;Fu Yuexian;Qiu Lin;Tian Xiaofei(Department of Burns and Plastic Surgery of Children’s Hospital of Chongqing Medical University,Ministry of Education Key Laboratory of Child Development and Disorders,China International Science and Technology Cooperation Base Child Development and Critical Disorders,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,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,国家儿童健康与疾病临床研究中心(重庆),400014

出　　处：《中华整形外科杂志》2020年第7期757-763,共7页Chinese Journal of Plastic Surgery

摘　　要：目的分析单纯性并指畸形分离手术术后畸形的常见表现,并探讨其相应的再修复方式。方法回顾重庆医科大学附属儿童医院烧伤整形外科2013年6月至2018年6月收治的25例单纯性并指术后畸形的患儿,男性13例,女性12例,平均年龄3岁2个月。通过调查初次手术时情况,包括初次手术年龄、是否植皮以及术后有无感染等,分析术后畸形发生的可能原因;通过形态学观察总结术后畸形的常见类型,回顾再次手术修复的主要方式,随访时从指蹼形态、手指形态、指甲形态及皮肤色差4个方面评价再修复手术后畸形的改善情况,以提出针对这类术后畸形有效的修复方案。结果初次手术平均年龄1岁5个月,15例术前皮肤并连紧张没有植皮,4例有伤口感染史;术后发生指蹼畸形27个、指体畸形53指、指甲畸形46个、皮肤明显色差15指。再修复手术中,采用Z成形加宽或皮瓣修复所有指蹼畸形,其中,13例采用双翼皮瓣成形指蹼;指体畸形均采用多Z成形松解并保留软化的瘢痕皮肤,形成锯齿状皮瓣覆盖大部分创面,剩余创面行全厚植皮;指甲畸形,14个甲上皮歪斜的行指甲邻近皮瓣推进包裹甲缘,余未做特殊处理;皮肤色差采用Z成形错开原有大块植皮皮片,切除颜色过深皮肤,采用质地相似区域皮片植皮。再修复术后平均随访时间33个月,所有指蹼均达正常的深度及宽度;除1指侧偏矫正不全外,其余指体畸形得以矫正;除10个指甲上皮歪斜有改善外,其余指甲畸形无改善;所有病例皮肤色差均有明显好转。结论(1)单纯性并指术后畸形的发生可能与初期手术时伤口缝合张力大(勉强不植皮)以及伤口感染有关;(2)再修复手术应在初次手术后1年左右即瘢痕软化后进行;(3)指蹼畸形的再修复均应采用皮瓣成形指蹼,双翼皮瓣适用性广、成形指蹼形态好;(4)指体挛缩修复时保留软化的瘢痕皮肤可以显著减少植皮面�Objective To evaluate the clinical performance of postoperative deformity after the release of simple syndactyly,and to discuss the corresponding method for repair.Methods Clinical data of 25 children with postoperative deformities after simple syndactyly releasing were reviewed retrospectively in the past 5 years,including 13 males and 12 females,with an average age of 3 years and 2 months.The possible causes leaded to postoperative deformity were analyzed by investigating the data of the first operation,including the age of the first operation,whether there was skin graft and whether there was postoperative infection.The common types of postoperative deformities were summarized through morphological observation,and the main methods of reoperation repair were reviewed.During follow-up,the improvement of postoperative deformities after repair was evaluated from the four aspects of webbed shape,finger shape,fingernail shape and skin color difference,so as to propose an effective repair plan for such postoperative deformities.Results The average age of the first operation was 1 year and 5 months,15 cases had no skin graft with tense skin,and 4 cases had a history of wound infection.The postoperative deformities of simple syndactyly can be summarized in four main categories:web deformity in 27 webs,finger deformity in 53 fingers,nail deformity in 46 nails and skin color difference in 15 fingers.During the revision surgery,for web deformity,Z-plasty technique were used to widen narrow webs,the flaps were used to reconstruct the recurred webs and the double wing flap were used in 13 webs.For finger deformity,in all cases,most of scar skin was reserved and released by multiple Z-plasty incisions to extend and straighten the fingers,while full-thickness skin grafting was employed if lacking of enough skin to close wound.For nail deformity,using the adjacent flap pushed forward to wrap the nail margin in 14 crooked nail cuticles and others remained untreated.For skin color difference,using z-plasty incision to break the

关 键 词：并指 并发症 挛缩 瘢痕 修复 

分 类 号：R726.8[医药卫生—儿科]