连续Y-V-Z成形术修复手部条索状瘢痕挛缩

Running Y V Z plasty for linear scar contracture of the hand

目的介绍修复手部条索状瘢痕挛缩的Ｙ－Ｖ－Ｚ成形术。方法利用条索状瘢痕两侧正常皮肤的伸展性，在瘢痕表面设计连续“Ｙ”形切口，每个“Ｖ”形皮瓣尖端的角度为６０～８０度，延伸为“Ｙ”下端切口的长度是“Ｖ”形瓣臂长的１／３～１／２。切开皮下组织后不做皮下分离，两侧切缘呈“Ｗ”状。将“Ｖ”形皮瓣与对侧组织瓣相互嵌插缝合即可延长瘢痕，其长度可达到挛缩完全松解的目的。术后切口呈双“Ｚ”字形。结果临床应用于８例２５个手指屈面瘢痕挛缩，近节指间关节欠伸４５度以上者；和另４例虎口挛缩，均为中、轻度。术后皮瓣完全成活，随访６个月～１年，所有手指伸直达０度，近节指间关节主动屈曲达９０度左右；虎口开大达正常范围。结论连续Ｙ－Ｖ－Ｚ成形术设计简单、操作方便、疗效满意，是修复手部条索状瘢痕挛缩较好方法之一。

Objective To report the method of running Y V Z plasty for release of linear scar contracture in the hand. Methods Running Y V Z plasty was designed according to skin elasticity on both sides of the scar so that the scar was lengthened and the contracture released. The procedure was performed to correct flexion contracture in 25 fingers of 8 cases and widen first web space in 4 cases. All cases were followed up for 6～12 months. Results All flaps survived after the operation. The fingers could extend completely and the PIP joints could flex to 90°. The 4 first web spaces were widened to normal extent. Conclusion Running Y V Z plasty is a simple, practicable and effective technique for release of linear scar contracture of the hand.