指背五边形皮瓣重建先天性并指指蹼

Dorsal pentagonal flap for web space reconstruction in trealment of congenital syndactyly

目的介绍一种并指分指后不需植皮指蹼一期重建的方法。方法10例先天性并指患儿，在相邻两个并指的近节指背侧设计五边形皮瓣，皮瓣顶角在两指间正常指蹼掌侧缘平面，两个侧角在两指侧背缘正常指蹼背侧缘平面，两个底角在掌指关节背侧中心。并指分指后，用形成的五边形皮瓣一期重建指蹼，共重建17个指蹼。结果所有指蹼一期获得重建，指蹼区不需植皮，指背创面直接缝合。术后所有皮瓣均存活。随访4～25个月，平均15个月，指蹼外观和功能良好。结论采用指背五边形皮瓣能够达到一期重建指蹼不需植皮的目的，且损伤小，手术简单。对于多指并指患者，可同时重建两个指蹼。

Objective To introduce a new technique for primary reconstruction of the web space after dividing syndactylous fingers without skin graft. Methods A pentagonal flap over the dorsum of the proximal phalanx was designed in 10 cases of congenital syndactyly. The base of the flap was at the metacarpophalangeal joint level. The vertex angle was at the palmar level of the normal web space, while the lateral angles were at the dorsal level of the normal web space. After the fingers were separated, the web was primarily reconstructed by the pentagonal flap. This technique has been used in 17 webs of 10 congenital syndactyly children. Results All the flaps survived and all the webs were reconstructed primarily without skin graft. The dorsal defects were closed directly. The patients were followed for 4 to 25 months, with an average of 15 months, and demonstrated normal function and good esthetic appearance. Conclusion Utilization of dorsal pentagonal flap can achieve primary web space reconstruction without the need of skin graft. This technique causes less trauma and is easy to master. It can be applied to reconstruct two web spaces in multiple syndactyly cases.