Bell-bottom皮瓣在足部小趾多趾伴第4、5趾并趾畸形治疗中的应用  

Application of bell-bottom flap for reconstruction of the web space in the fifth and fourth toe polysyndactyly

作　　者：陈敏建[1] 宋湧 汪怡[1] 陈白烨[1] Chen Minjian;Song Yong;Wang Yi;Chen Baiye(Department of Plastic Surgery,Fujian Maternity and Child Health Hospital Affiliated to Fujian Medical University,Fujian Key Laboratory of Women and Children’s Critical Diseases Research,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属福建省妇幼保健院整形外科,福建省妇儿重大疾病研究重点实验室,福州350001

出　　处：《中华整形外科杂志》2021年第9期981-986,共6页Chinese Journal of Plastic Surgery

摘　　要：目的探讨bell-bottom皮瓣用于足部小趾多趾伴第4、5趾并趾畸形趾蹼重建的临床效果。方法回顾性分析2014年6月至2020年5月福建省妇幼保健院整形外科收治的采用bell-bottom皮瓣重建趾蹼的小趾多趾伴第4、5趾并趾畸形患儿临床资料。术中切除多趾,用关节面成形及关节囊修补矫正小趾腓偏畸形,用bell-bottom皮瓣重建趾蹼,趾侧创面用多趾残余皮肤软组织形成3个皮瓣修复关闭,同时延长小趾远端软组织长度,形成与正常小趾类似外观。随访第4、5趾术后外观、功能、重建趾蹼的宽度、深度、坡度及术后并发症情况。结果共纳入小趾多趾伴第4、5趾并趾畸形患儿40例(男22例,女18例,年龄6个月至3岁,平均11个月)46侧足,其中完全性并趾合并多趾19侧足,不完全性并趾合并多趾27侧足。46侧足术中均切除多趾、分离并趾,皮瓣均全部成活,无皮瓣坏死,均无需植皮,重建了趾甲皱襞和掌侧屈曲横纹,无感染和皮肤坏死。术后随访6个月至3年,平均随访20个月,重建趾蹼宽度、深度及坡度正常或接近正常,小趾腓偏得以完全矫正,短趾畸形得到不同程度改善,无趾侧瘢痕挛缩,甲襞外观与正常小趾基本一致。结论Bell-bottom皮瓣治疗小趾多趾并趾畸形,能够重建形态良好的趾蹼,避免了植皮,重建的小趾及其趾甲皱襞的形态自然,掌侧屈曲横纹连线弧度自然,是一种矫正小趾多趾并趾畸形的好方法。Objective To investigate the clinical effect of the bell-bottom flap in the treatment of multiple little toes with syndactyly deformity of the 4th and 5th toes.Methods Forty cases(22 males and 18 females)of multiple little toes with syndactyly deformity of the 4th and 5th toes were treated in the Plastic Surgery Department of Fujian Maternal and Child Health Hospital from June 2014 to May 2020.The age of patients ranged from 6 months to 36 months,with an average of 11 months.There were 46 feet,among which 19 cases had a complete fusion,and 27 cases had an incomplete fusion.During the operation,the polydactyly was removed,the fibula-deviation deformity of little toes was corrected with the articular surface formation and joint capsule repaired.The bell-bottom flap was used to reconstruct the webbed of the toe,and the wound surface on the side was closed with three flaps made up of the residual skin soft tissue of multiple little toes.Meanwhile,the soft tissue length at the distal end of the little toe was extended,and the toenail fold and palmar flexion transverse lines were reconstructed to form a similar appearance to the normal.Results All the flaps in all 46 feet survived with no flap necrosis,skin grafting,or infection.After 6 to 36 months of follow-up(averagely,20 months),the width,depth,and slope of the reconstructed toe webbed were normal or close to normal,the fibula deviation of the small toe was corrected entirely,the deformity of the short toe was improved in varying degrees,no toe scar contracture,and the appearance of nail fold was consistent with that of the normal small toe.Conclusions Bell-bottom flap is a good method to correct the deformities of small toe polysyndactyly,which can reconstruct the well-formed webbed,no skin grafting,with the shape of small toenail fold and small toe naturally,and the radians of palmar flexion line naturally.

关 键 词：多指(趾)畸形 并指(趾) 足 Bell-bottom皮瓣 

分 类 号：R726.8[医药卫生—儿科]