趾横行V-Y推进皮瓣修复同侧趾腓侧皮瓣供区  

Repair the donor site of ipsilateral fibular hallux flap with transverse V-Y advancement flap of the great toe

作　　者：梁高峰 董俊文 权小波 滕云升 贾宗海 于湖 梁虹 张满盈 张朝 郭永明 LIANG Gaofeng;DONG Junwen;QUAN Xiaobo;TENG Yunsheng;JIA Zonghai;YU Hu;LIANG Hong;ZHANG Manying;ZHANG Chao;GUO Yongming(Department of Hand Surgery,Institute for Hygiene of Ordnance Industry(521 Hospital of Weapon Industry),Xi'an 710065,China)

机构地区：[1]兵器工业卫生研究所(兵器工业五二一医院)手外科,西安710065

出　　处：《中华显微外科杂志》2022年第5期493-497,共5页Chinese Journal of Microsurgery

基　　金：陕西省重点研发计划(一般项目-社会发展领域)(2022SF-016)。

摘　　要：目的探讨应用趾横行V-Y推进皮瓣修复同侧趾腓侧皮瓣供区的临床疗效。方法2017年1月至2020年1月,兵器工业五二一医院手外科对20例患者的趾腓侧皮瓣的供区采用趾横行V-Y推进皮瓣修复,其中男16例,女4例,平均年龄33(18~52)岁。先将趾腓侧皮瓣供区缝合缩小创面,剩余创面的横行宽度0.4~1.6 cm,创面的面积为0.5 cm×0.8 cm~1.6 cm×1.8 cm。随后采用同侧趾横行V-Y推进皮瓣修复缩小的创面。V-Y皮瓣横行推进距离0.2~0.8 cm,皮瓣切取的面积为1.0 cm×1.4 cm~1.8 cm×2.4 cm。随访截止时间为2021年7月,随访内容包括:V-Y推进皮瓣成活情况,切口有无感染,皮瓣外形、质地、纹理及感觉,皮瓣及趾有无疼痛,供区趾及皮瓣对冷耐受性,供区趾及皮瓣瘢痕情况,供区趾外观、感觉及屈伸功能,供区趾有无特殊不适以及是否影响行走等功能。结果术后随访12~18(平均14)个月,趾横行V-Y推进皮瓣全部成活,趾供区切口无感染,切口I期愈合。皮瓣外形、纹理及质地与对侧趾相同位置皮肤接近,趾横行V-Y推进皮瓣及供区趾TPD均为4~7 mm。用视觉模拟量表(VAS)评价皮瓣对冷的耐受性平均为0.3分,供区趾对冷的耐受性平均为0.6分。用温哥华瘢痕量表评分(VSS)评价皮瓣的瘢痕平均为0.2分,供区趾瘢痕平均为1.2分。供区趾外观与对侧趾外观无明显差别,V-Y推进皮瓣及供区趾均无疼痛等不适,所有病例供区足部行走、跑步、跳跃、踮脚时均无影响。结论采用趾横行V-Y推进皮瓣修复同侧小面积趾腓侧皮瓣供区,可获得满意的修复外形及功能,手术操作简单,创伤小,是一种安全、有效的治疗方法。Objective To explore the clinical application and effect of repairing the donor site of ipsilateral fibular hallux flap with the transverse V-Y advancement flap of the great toe.Methods Form January 2017 to January 2020,the donor sites of the ipsilateral fibular hallux flap were repaired by the transverse V-Y advancement flap of the great toe in the Department of Hand Surgery,521 Hospital of Weapon Industry on 20 patients,including 16 males and 4 females with an average age of 33(18-52)years old.First,the donor site of the fibular hallux flap was sutured to reduce the size of wound.The width of the remaining wound was 0.4 to 1.6 cm,and the area of the remaining wound was 0.5 cm×0.8 cm-1.6 cm×1.8 cm.Then the remaining wound was repaired with the transverse V-Y advancement flap of the ipsilateral great toe.The distance for transfer of transverse advancement V-Y flap was 0.2-0.8 cm,and the area of the transverse V-Y advancement flap was 1.0 cm×1.4 cm-1.8 cm×2.4 cm.The end of postoperative follow-up was scheduled in July 2021.The follow-up items included:survival of the transverse V-Y advancement flap,wound infection,appearance,shape,texture and sensation of the V-Y advancement flap,pain on the V-Y advancement flap and the great toe,cold tolerance and the scar condition at the donor site of the ipsilateral fibular hallux flap and the V-Y advancement flap,the appearance,sensation and flexion and extension of the great toe at the donor site,other discomforts in the donor site of great toe,walking and other functions affected by the discomforts.Results The postoperative follow-up lasted from 12 to 18(average of 14)months.All the V-Y advancement flaps survived without infection at the donor sites of the great toe,and donor sites healed primarily.The appearance,shape and texture of the advancement V-Y flap were close to the skin of the same area of the contralateral great toe.The TPD of the V-Y advancement flap and the ipsilateral great toe ranged from 4 to 7 mm.The average score of the Visual analog scale(VAS)was 0.3

关 键 词：V-Y推进皮瓣 趾 趾腓侧皮瓣 供区 

分 类 号：R622[医药卫生—整形外科]