先天性完全并指畸形矫正术后继发畸形的诊疗策略  

The strategy of diagnosis and treatment of secondary congenital total syndactyly after surgical correction

作　　者：裴蛟淼 张娟 窦文婕 陈永军 张仔昂 宋保强 PEI Jiao-miao;ZHANG Juan;DOU Wen-jie;CHEN Yong-jun;ZHANG Zi-ang;SONG Bao-qiang(Department of Plastic Surgery,the First Affiliated Hospital of Air Force Military Medical University,Shanxi Province,710032,China)

机构地区：[1]空军军医大学第一附属医院整形外科,陕西西安710032

出　　处：《中国医疗美容》2022年第11期46-50,共5页China Medical Cosmetology

摘　　要：目的 探讨先天性完全并指畸形矫正术后继发畸形的临床特点,总结并指术后瘢痕挛缩及指蹼爬移的手术经验及诊疗效果。方法 回顾分析2010年1月至2018年12月空军军医大学第一附属医院整形外科收治的16例完全性并指术后继发畸形患儿的临床资料,归纳术后并发症特点及其治疗方案,分析继发畸形矫正术后手指运动功能恢复、指蹼高度及瘢痕情况,总结治疗经验和手术效果。结果 本研究纳入先天性完全并指术后继发畸形患儿16例,男女比例:12:4,单侧13例、双侧3例,共19个并指。纳入病例均有不同程度指间关节屈曲畸形,伴掌指关节屈曲畸形者5例,Ⅱ度以上指蹼爬移8例,两次手术间隔时长:6月~14年;指体瘢痕松解后行连续Z成形术,指蹼爬移采用五瓣法矫正8例,联合皮片移植者6例。受累手指:中、环指并指14个,环、小指并指3个,示、中指并指2个。术后无伤口感染、皮瓣及皮片血运障碍。畸形矫正效果良好,重建指蹼发生Ⅱ度指蹼爬移者1例,术后1年行Z成形术得以矫正。手术切口瘢痕采用温哥华瘢痕量表评分:9例≤4分,6例5分,1例6分。总活动度评级:优秀:5例,良好:8例,尚可3例。结论 完全性并指分指术后常见继发畸形以指体屈曲和指蹼爬移为主,可通过Z成形和五瓣法予以矫正,必要结合小面积皮片移植可获得良好的治疗效果。Objective To explore the surgical procedures for scar contracture after correction of congenital complete syndactyly.To summarize the experience and outcomes of the treatment for secondary digital contracture deformity and web creep. Methods Retrospectively analyzed the clinical data of 16 cases of secondary deformities after complete syndactyly correction procedures from January 2010 to December 2018 in the first affiliated hospital of the Air Force Military Medical University. The characteristics of complications and treatment strategies were collected. The scar conditions were scored. The functions and appearance of fingers and webs were evaluated. Surgical procedures and outcomes were summarized. Results Sixteen children with secondary deformities after syndactyly release surgery were enrolled in this study. The male to female ratio was 12:4, including 13 unilateral and 3 bilateral cases.There were 5 cases of metacarpophalangeal joint flexion deformity and 8 cases of web creep above degree Ⅱ. The interval between two procedures was 6 months to 14 years. After the release of the digital scar, continuous Z-plasty was performed. The five-flap method was applied to correct the web creep in 8 cases. Free skin grafting was performed in 6 cases. Affected fingers of digital connection: 14in middle and ring fingers, 3 in ring and little fingers, and 2 in index and middle fingers. There was no wound infection, necrosis of flap and skin graft after operations. The deformities were corrected with good outcomes. One case with Ⅱ degree of web creep was corrected by Z-plasty one year later. The Vancouver Scar Scale of surgical incision was ≤4 points in 9 cases, 5 points in 6 cases, and 6 points in 1 case. Total active movement rating: excellent: 5 cases, good: 8 cases, fair in 3 cases. Conclusions The common deformities after complete syndactyly are digital flexion deformity and web creep. Z-plasty can be used to correct finger deformities. Five-flap method could applied to reconstructed finger web. Small area of skin

关 键 词：并指 并发症 瘢痕 指蹼爬移 皮瓣转移 

分 类 号：R658.2[医药卫生—外科学]