吻合血管的跗外侧皮瓣修复重度虎口挛缩的临床研究

An clinical study of severe contractures of the first-web space repaired with anastomosised free lateral tarsal flap

目的 探讨吻合血管的跗外侧皮瓣游离移植治疗重度虎口挛缩的临床疗效.方法 对15例重度虎口挛缩患者行切开、松解、开大或重建;设计跗外侧皮瓣游离移植,皮瓣切取面积：3cm×6cm～4cm×9cm.将第1,2掌骨头用克氏针U形撑开固定3～4周,术后进行功能康复锻炼.结果 15例皮瓣全部成活,随访到10例,随访时间5个月～3年,平均13个月.所有皮瓣质地柔软,形态近似正常,功能满意,供区无功能障碍.按照Jensen及顾玉东等测定方法及TAM系统对虎口开大和手功能进行评价,虎口开大优8例,良2例,手功能评价优8例,良2例.结论 应用跗外侧皮瓣游离移植修复重度虎口挛缩,可获得良好的外形及功能,是重度虎口挛缩修复较为理想的手术方法.

Objective To discuss the method and outcome of severe contractures of the first-web space repaired wth anastomosised free lateral tarsal flap. Methods According to solution, enlargement or reestablish of 15 cases contractures of the first-web space the incision,, designed size of lateral tarsal flap and to use Kirschner wire U shape brace between the first and the second head of metacarpal bone meanwhile fix for 3-4weeks. Post-operation were to carry out functional rehabilitation and exercise. lateral tarsal flap cut areas maximum 9cm×4cm, minimum 6cm×3cm. Results All cases survived and there were no other complications, after 5 months-3 years following-up among 10 of 15, average 13 months, all the flaps showed texture soft, shap approximation normal, function satisfaction and the action donor site of foot was no effect. According to assay method of Jensen and GuYudong and judgement of TAM system for hand, enlargement of the first web space 18 cases well, 2 cases fine, and judmement function of hand 8 cases well, 2 cases fine. Conclusion It is relatively ideal operation method to repair the contracture of the first-web space with the lateral tarsal flap free grafting through anastomosis blood vessel and gain outline form and function well.