先天性单纯并指畸形的治疗

Treatment of simple congenital syndactyly

目的介绍先天性单纯并指畸形的治疗方法。方法对38例先天性单纯并指的患者,采用"M-∧"形皮瓣再造第2～4指指蹼,四边"Z"字形皮瓣再造虎口,多"Z"字成形分离指体,指端两个方向相反的三角形皮瓣覆盖末节指体侧方,全厚皮片植皮覆盖指体相对缘皮肤缺损。结果本组病例随访1～3年,多数患儿家长表示满意,但有11例出现并发症:3例出现动、静脉危象,2例指体侧方植皮坏死,4例重建的指蹼逐渐向远侧爬伸形成不全并指,2例出现手指屈曲畸形。结论先天性单纯并指的治疗可在出生后3个月开始,应先分离手指长度差异较大的并指,"M-∧"形皮瓣是指蹼再造的理想方法,并指掌、背侧皮肤主要用于指蹼的成形,分指后手指相对缘皮肤缺损应采用全厚层皮片覆盖以避免术后皮片的挛缩。

Objective To introduce our experience of treating simple congenital syndactyly. Methods In a series of 38 cases, including 26 male patients and 12 female patients, we used the following approach to separate the syndactyly. M-shaped flap over the dorsum and ∧ -shaped flap over the palm of the syndactyly were designed to reconstruct the 2nd - 4th web. Double Z-plasty was done to deepen and enlarge the first web. Multiple Z-plasty was done to separate the syndactyly and skin defects over the adjacent sides of the separated fingers were covered with full-thickness skin graft, which was taken from contralateral groin area. Two triangle flaps of opposite directions from the distal pulp were transferred to cover skin defects of the separated distal phalanges. Results All cases were followed for 1 year to 3 years. Most parents were satisfactory of the results. There were 11 patients who sustained postoperative complications. These complications included 3 eases of vascular compromise, 2 eases of skin graft necrosis, 4 eases of web creeping, and 2 eases of flexion deformity. Conclusion Based on our series, we think 3 months of age is the optimal time to separate syndaetyly. The first step is to separate the syndactyly with different lengths to minimize the influence over finger development. M-∧ flap is an optimal method to reconstruct finger web. Skin over the syndaetyly is the source of flaps for web reconstruction. Skin defects over adjacent sides of the separated fingers should be covered by full-thickness skin graft to avoid flexion deformity due to skin contracture.