踇甲瓣切除后供足创面修复的远期随访

Long-term follow-up of the coverage of the donor defect of wrap-around flap transfer

目的探讨踇甲瓣供足创面皮瓣及植皮坏死的原因和防治方法。方法回顾性分析2000年5月至2008年9月收治的120例游离踇甲瓣再造拇指患者,根据供足创面不同的修复方法分两组:A组76例,应用中厚或全厚皮片覆盖;B组44例,第2足趾剥离皮瓣加有限植皮覆盖。结果120例患者均获得随访,随访时间1～7年,平均3.2年。2例供足踇趾胫侧舌状皮瓣尖端坏死或部分坏死,10例创面植皮部分坏死,2例第2趾剥离皮瓣部分坏死;其中2月内换药愈合者10例,超过2月换药愈合者3例,超过2月经手术处理后愈合者1例。除有些患者对供足病程嫌过长外,全部患者对外形及功能感觉满意。结论踇趾胫侧舌状皮瓣加游离植皮是修复踇甲瓣供足创面的理想选择,完善手术操作可有效避免供足创面皮瓣及植皮坏死。

Objective To explore the treatment and causation of necrosis of skin flap and free skin graft resurfacing donor defect after incising wrap-around flap. Methods A retrospective study was conducted to analyze 120 cases with thumb reconstruction by transplanting wrap-around flap. Based on the operative techniques all cases were classified into two groups： A group, 76 cases, transplanted intermediate or thick split-thickness skin graft to repair the defect after incising wrap-around flap, and B group, 44 cases, applied the second toe free flap and limited dermoplasty. Results All cases had a mean follow-up of 3.2 years （from 1 to 7 years）. Among the 120 cases, necrosis occured in the tibial side of the gloss-shape flap partly or on the top in 2 cases; partly in the dermoplasty area of the raw surface in 10 cases. Of all cases, 10 were healed through dressing changes in 2 months; 3 healed through dressing changes in more than 2 months; 1 healed after reoperation in more than 2 months. All the patients were satisfied with the appearance and function except for a few patients who disaffected with the long term treatment. Conclusion Free skin graft transplantation is a ideal method to resur- facing donor defect after incising the wrap-around flap. Unsuitable operation is the main causation of necrosis of skin flap and free skin graft, so the regular covering methods should be emphasized.