第一趾蹼处三叶皮瓣治疗多手指屈曲畸形

Correction of multi-digit flexion contracture deformity with vascularized trifoliated flap from first web of the foot

目的介绍应用第一趾蹼处三叶皮瓣治疗多手指屈曲畸形的临床效果。方法对5例11指屈曲畸形的患者,应用第一趾蹼处(足母)趾腓侧皮瓣、第二趾趾腹皮瓣及跖底皮瓣组成的三叶皮瓣进行修复。皮瓣以第一跖背或跖底动脉为主干,带跖背静脉,与患指掌侧总动脉或掌浅弓及掌背静脉吻合。结果术后皮瓣全部存活。4例获得6个月～2年随访,1例失访。4例9指伸直位,手指伸屈功能良好,皮瓣饱满,质地及外形好。皮瓣两点分辨觉为5～7mm。足部供区有瘢痕,行走无影响。结论第一趾蹼处三叶皮瓣是修复相邻2～3指严重瘢痕增生或手指严重屈曲畸形矫形术后掌侧软组织缺损的理想皮瓣之一。

Objective To introduce the clinical application of vascularized trifoliated flap from the fast web of the foot for correction of muhi-digit flexion contracture. Methods 11 digits of 5 cases with flexion contracture were corrected by contracture release and skin coverage with vascularized trifoliated flap from the first web of the foot. The flexion contracturo located at the MP and PIP joints and ranged from 60-90 degrees. Major soft tissue defect occurred after contracture release. Meanwhile, the tendons and bones of the fingers were exposed requiring flap coverage. The trifoliated flap was composed of fibular side flap of the great tee, pulp flap of the second toe, and plantar metatarsal flap. The flap was pedicled with the first dorsal or plantar metetarsal artery and drained by dorsal pedal veins. The vessels were anastomosed to the common digital artery or the superficial palmar arch and the dorsal metacarpal veins respectively. Results All flaps survived postoperatively. 4 cases were followed for 6 months to 2 years. 1 case was lost to follow-up. 9 fingers of 4 cases were fully extended. Flexion and extension of the fingers was satisfactory. The flaps were of good appearance and color. Two-point discrimination was 5 nun to 7 ram. Donor feet were with slight scar and normal gait. Conclusion Trifoliated flap from first web of the foot is one of the best flaps to repair muhi-digit flexion contracture deformity.