掌背岛状皮瓣治疗指蹼瘢痕挛缩的疗效

EFFECTIVENESS OF DORSAL METACARPAL ISLAND FLAP FOR TREATING SCAR CONTRACTURE OF FINGER WEB

目的总结在指蹼瘢痕挛缩治疗中采用掌背岛状皮瓣重建指蹼的方法及疗效。方法 2009年6月-2010年12月,收治指蹼瘢痕挛缩患者10例。男6例,女4例;年龄14～57岁,平均30岁。均为单个指蹼瘢痕挛缩。外伤后瘢痕增生挛缩8例,烧伤后瘢痕挛缩1例,并指分指术后瘢痕挛缩1例。虎口挛缩1例,示中指指蹼挛缩3例,中环指指蹼挛缩5例,环小指指蹼挛缩1例。病程3～9个月,平均5个月。指蹼最大外展度10～20°。瘢痕切除后指蹼间缺损范围为2.0 cm×1.0 cm～3.0 cm×1.8 cm,采用大小为3.5 cm×1.2 cm～4.0 cm×2.0 cm的掌背岛状皮瓣重建指蹼。供区直接缝合或局部皮瓣移位修复。结果术后第2天1例皮瓣出现静脉危象,对症处理后皮瓣成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区皮瓣均成活,切口Ⅰ期愈合。10例均获随访,随访时间6～15个月,平均9个月。重建指蹼外形良好,其中1例虎口挛缩者,最大外展度达80°;余9例指蹼最大外展度为35～45°,平均40°。8例瘢痕增生患者,随访期间未见再次瘢痕爬行、挛缩。结论采用掌背岛状皮瓣重建指蹼治疗指蹼瘢痕挛缩,可获得较好的指蹼外观及功能。

Objective To investigate the effectiveness of dorsal metacarpal island flap for treating scar contracture of the finger web.Methods Between June 2009 and December 2010,10 patients with scar contracture of the finger web were treated.There were 6 males and 4 females with an average age of 30 years（range,14-57 years）.Scar contracture was caused by injury in 8 cases,by burn in 1 case,and by operation in 1 case.The locations were the 1st web space in 1 case,the 2nd web space in 3 cases,the 3rd web space in 5 cases,and the 4th web space in 1 case.The disease duration was 3 to 9 months with an average of 5 months.The maximum abduction was 10-20°.After web space scar release,the dorsal metacarpal island flap（3.5 cm × 1.2 cm-4.0 cm × 2.0 cm in size） was used to reconstruct web space（2.0 cm × 1.0 cm-3.0 cm × 1.8 cm in size）.The donor site was directly sutured or repaired with local flaps.Results At 2 days after operation,necrosis occurred in 1 flap,which healed by extractive treatment.The other flaps survived and wound healed by first intention;all the flaps at donor sites survived and incision healed by first intention.Ten patients were followed up 6 to 15 months（mean,9 months）.The reconstructed web space had good appearance,the maximum abduction was 80 ° in 1 case of the 1st web space scars contracture,and the maximum abduction was 35-45°（mean,40°） in the other 9 cases.In 8 scar patients causing by injury,no scar contracture recurred during follow-up.Conclusion It can achieve good results in appearance and function to use dorsal metacarpal island flap for treating scar contracture of the finger web.