腹部带蒂皮瓣修复先天性并指畸形的临床研究  

The clinical study of pedicle abdominal flaps used for congenital syndactyly release

作　　者：裴蛟淼 张娟 李杨 刘超华 宋保强 PEI Jiaomiao;ZHANG Juan;LI Yang;LIU Chaohua;SONG Baoqiang(Department of Plastic Surgery,The First Affiliated Hospital of Air Force Medical University,Xi'an 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：《中国美容整形外科杂志》2023年第5期293-296,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探讨采用腹部带蒂皮瓣治疗先天性并指畸形的临床效果。方法 回顾性分析自2008年9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32例完全性并指畸形患儿(39个指蹼)的临床资料。Ⅰ期腹部带蒂转移覆盖分指后继发创面,3周后皮瓣断蒂。记录手指运动功能、瘢痕指标及指蹼高度。结果 32例患儿获随访2~5年,1例于分指术后第7天皮瓣撕脱,撕脱皮瓣修剪为全厚皮回植覆盖创面;2例皮瓣尖端坏死,面积<0.5 cm^(2),湿敷换药后愈合;5例转移皮瓣局部略臃肿,去脂修薄后外观改善;其余患儿手指切口瘢痕质地柔软,厚度为1~3 mm,伴有较浅色素沉着,颜色正常至粉红。35个重建指蹼的手指活动无受限;4个指蹼在术后6~12个月出现指侧方瘢痕挛缩、手指背伸受限,给予瘢痕松解、植皮后功能恢复。2个指蹼出现Ⅱ度指蹼爬行至近节指骨1/3处,术后1年行瘢痕松解、五瓣法覆盖创面,指蹼成形良好;其余患儿重建指蹼为0、Ⅰ度。温哥华瘢痕量表瘢痕评分:≤3分7例,4分15例,5分10例。结论 腹部带蒂皮瓣可为修复完全性并指畸形提供充足的组织量,在无张力状态下闭合创面的同时覆盖外露骨及关节,是治疗先天性并指畸形的有效方法之一。Objective To investigate the efficacy of abdominal pedicle flap in the treatment of congenital syndactyly.Methods A total of 32 complete syndactyly(39 webs)paitents were treated by abdominal flaps from September 2008 to December 2018 in The First Affiliated Hospital of Air Force Medical University.The clinical data was retrospectively analyzed.In stage I operation,abdominal pedicle was transferred to cover the secondary wound after finger spltting,and the flap pedicle was severed 3 weeks later.The data of finger motor function,scar condition and web height were recorded and evaluated.Results The 32 patients were followed up for 2 to 5 years.One case of avulsion was occurred on the 7th day after stage I procedure.The avulsed flaps were trimmed to full-thickness skin graft and resurfaced the defects.Two cases of flap tip necrosis which less than O.5 cm^(2) were healed by dressing changes.Five cases skin flap transfer showed slight swelling and improved appearance after degreasing and thinning.The rest finger incisions were soft in texture,1 to 3 mm in height,light pigmentation with normal color to pink.No mobility dysfunction was observed in 35 reconstructed webs spaces.Lateral digital scar contracture and dorsalflexion was limited in 4 web in 6 to 12 months postoperatively.The scars were treated by skin graft.Two cases of web creep extended to 1/3 of the proximal phalanxes at grade I leading to fingers abduction limitation which cured by"five-flap"procedures one year later.While the other reconstruced webs recovered without dysfunction(O,I degree).The vancouver scar scale scored:7 cases≤3,15 cases=4,10 cases=5.Conclusions The pedicle abdominal flap could provide sufficient soft tissue for the repair of complete syndactyly.It is an feasible surgical procedure for syndactyly separation by tension-free closure and covering exposed bone and joints.

关 键 词：手畸形 并指 指蹼重建 皮瓣 

分 类 号：R658.2[医药卫生—外科学]