携带筋膜皮下瓣的[足母]趾腓侧皮瓣修复拇指及手指掌侧软组织缺损  

Fibular great toe flap carrying partial subcutaneous fascial flap in reconstruction of soft tissue defects in palmar side of thumbs and fingers

作　　者：李木卫 张喆 孟创 梁勇 黄少耿 张子清 LI Muwei;ZHANG Zhe;MENG Chuang;LIANG Yong;HUANG Shaogeng;ZHANG Ziqing(Department of Hand Surgery Ward One,the Longgang Orthopaedics Hospital of Shenzhen,Shenzhen,Guangdong Province 518116,China;Department of Hand Surgery,the Longgang Orthopaedics Hospital of Shenzhen,Shenzhen,Guangdong Province 518116,China)

机构地区：[1]深圳市龙岗区骨科医院手外科一病区,广东深圳518116 [2]深圳市龙岗区骨科医院手外科,广东深圳518116

出　　处：《中华显微外科杂志》2024年第5期555-559,共5页Chinese Journal of Microsurgery

基　　金：深圳市龙岗区医学重点学科建设经费资助(440307240221533600176);深圳市龙岗区医疗卫生科技计划项目(LGWJ2023-145)。

摘　　要：目的探讨携带部分筋膜皮下瓣的[足母]趾腓侧皮瓣联合全厚皮片移植修复拇、手指掌侧软组织缺损的方法及临床效果。方法2019年12月至2023年12月,深圳市龙岗区骨科医院手外科一病区应用携带部分筋膜皮下瓣的[足母]趾腓侧皮瓣修复拇、手指掌侧软组织缺损11例,男7例,女4例,年龄16~55岁,平均26岁。拇、手指软组织缺损面积4.0 cm×3.0 cm~6.0 cm×4.0 cm,术中切取携带部分皮下组织瓣的[足母]趾腓侧瓣修复软组织缺损,皮瓣切取面积4.0 cm×1.5 cm~6.0 cm×2.0 cm,皮瓣扩展的皮下组织瓣面积4.0 cm×1.5 cm~6.0 cm×2.0 cm。皮瓣所携带延伸组织瓣软组织缺损区应用足内侧皮片8例、小腿内侧皮片3例。皮瓣供区均直接缝合。所有患者术后定期门诊或视频、电话进行随访,观察外观、功能及供区愈合情况。结果本组11例皮瓣全部成活,其中1例植皮部分坏死,予换药后创面愈合。随访时间6~18个月,平均9个月。皮瓣的外形、质地和弹性良好,抓、捏、握功能良好;依据英国医学研究委员会(BMRC)感觉恢复评定标准,皮瓣区域感觉均恢复S3+;植皮区域感觉恢复6例S3,5例S3+。冷不耐受症状严重程度(CISS)评分,8例患者未出现冷不耐受,3例出现轻度冷不耐受,评分分别为4、12、36分。按中华医学会手外科学会上肢部分功能评定试用标准评定,优10例,良1例。供区遗留线形瘢痕,末次随访温哥华瘢痕量表评估(VSS)评分为(2.42±0.75)分,瘢痕平坦或高出皮肤小于1~2 mm,颜色接近周围正常皮肤,柔软性良好,无瘙痒或任何类型的疼痛。结论携带筋膜皮下瓣的[足母]趾腓侧皮瓣结合全厚皮片植皮修复拇、手指掌侧较大面积软组织缺损,可避免供区植皮,减少了供区创伤,是一种可供选择的术式。Objective To discuss the method and clinical outcomes in reconstruction of soft tissue defects on palmar side of thumbs and fingers by transfer of combined full-thickness skin grafting with a great toe fibular flap carrying partial subcutaneous fascial flap.Methods From December 2019 to December 2023,11 patients with soft tissue defects on the palmar side of thumbs and fingers were treated in the Department of Hand Surgery Ward One,the Longgang Orthopaedics Hospital of Shenzhen.The patients were 7 males and 4 females,aged 16-55 years old with 26 years old in average.Fibular great toe flaps carrying partial fascial subcutaneous flap were employed.The soft tissue defects of thumbs and fingers were 4.0 cm×3.0 cm-6.0 cm×4.0 cm in size.Fibular great toe flaps carrying partial fascial subcutaneous tissue flap were harvested for reconstruction of the soft tissue defects in palmar digits.The sizes of flaps were 4.0 cm×1.5 cm-6.0 cm×2.0 cm,and the extended area by subcutaneous tissue flap was 4.0 cm×1.5 cm-6.0 cm×2.0 cm.Eight medial foot skins and 3 medial calf skins were applied.All donor sites were directly sutured.All patients were included in the scheduled postoperative follow-up by regular visis of outpatient clinic,and by video and telephone to observe the appearance,function and healing of the flaps and donor sites.Results All 11 flaps survived,including 1 that had partial necrosis,and healed after dressing changes.The follow-up ranged from 6 to 18 months,with an average of 9 months.Good shape,texture and elasticity of the flaps were achieved.The grasping,pinching and holding functions of digits were all good.According to the British Medical Research Council(BMRC)sensory recovery criteria,the sensation of the flap was recovered to S 3+,with 6 skin graft areas recovered to S 3 and 5 recovered to S 3+.Eight patients had no cold intolerance but 3 had mild cold intolerance with Cold Intolerance Symptom Severity(CISS)scores of 4,12 and 36,respectively.According to the Evaluation Trial Standards of Upper Limb Parti

关 键 词：[足母]趾腓侧皮瓣 拇指 指 软组织缺损 修复 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]