双翼皮瓣在小趾多趾伴4、5趾并趾畸形矫正中的应用

Application of dorsal double-wing flap for reconstruction of the web space in the fifth and fourth toe polysyndactyly

目的探讨双翼皮瓣在小趾多趾伴4、5趾并趾畸形矫正中的应用。方法2013年1月至2016年12月共收治小趾多趾伴4、5趾并趾畸形99例112只足,其中4、5趾不全性并趾75只足,完全性并趾37只足,小趾主干趾均存在不同程度的腓侧偏斜畸形及短趾畸形。手术切除多趾,采用关节面成形或楔形截骨矫正小趾腓侧偏斜。77只足采用尖端凸V形双翼皮瓣,35只足采用尖端凹V形改良双翼皮瓣重建趾蹼,利用多趾皮肤关闭趾侧方创面,同时延长小趾顶端软组织长度。结果所有病例切除多趾同时分离并趾,创面均能一期关闭,未植皮。术后平均随访27个月,重建的趾蹼宽度、坡度正常,趾蹼正常或略深。小趾腓侧偏斜完全矫正,短趾畸形得到不同程度改善。结论双翼皮瓣用于小趾多趾伴4、5趾并趾畸形的矫正,无需植皮,重建深度足够的趾蹼结合小趾顶端软组织延长,可以改善小趾短趾畸形。尖端凹V形的改良双翼皮瓣成形趾蹼后掌侧皮肤更美观。

Objective To explore the application of dorsal double-wing flap for reconstruction of the web space in the fifth and fourth toe polysyndactyly.Methods 99 patients (112 feet) with polysyndactyly of the fifth toe fused with the fourth toe were treated, 75 of which were incomplete and 37 were complete fusion of the fourth and fifth toes. The fifth toes showed various degrees of fibular deviation and minor deformities. Excision of polydactyly and then with the use of wedge osteotomy correction deviation. Using 77 traditional and 35 modified dorsal double-wing flap for reconstruction of the web space, and close the lateral sides of toes with flaps from polydactyly. The distal soft tissue of polydactylies were used lengthening the reconstructed fifth toes.Results Polydactyly excision and syndactyly releasing in same procedure and lateral sides of the toes were all closed with flaps without skin grafts. Patients were followed up average 27 months after operation, the constructed web space showed good appearance, with slightly deeper or normal location. The fibular deviation were complete correction, and minor deformities were improved.Conclusions The dorsal double-wing flap is used for reconstruction of the web space in the fifth and fourth toes polysyndactyly without skin grafts. Reconstruction of the web depth, combined with lengthen distal end of the fifth could improve the toe appearance. Compared with traditional dorsal double-wing flap reconstruction of the web space, the modified flaps have better appearance in palmar of foot.