掌背皮瓣在幼儿先天性并指分指中的应用

Application of island dorsal flap in congenital syndactyly release

目的探讨带血管蒂掌背皮瓣在幼儿先天性并指分指术中的应用。方法2011年9月至2013年8月收治9例单纯性并指患儿（男6例，女3例），其中完全性并指7例，不完全性并指2例。并指分指术中采用带血管蒂掌背皮瓣转移行指蹼重建，远端创面全部由Z形皮瓣覆盖，近端相对缘的创面由掌背皮瓣向远侧转移后进行修复，皮瓣供区进行直接缝合，术后行石膏托外固定3周。结果9例患儿术中掌背皮瓣顺利分离，转移后完整重建指蹼，分指后创面均未使用植皮覆盖，所有创面一期闭合，平均手术时间为1．2h，术后皮瓣均顺利存活。术后随访时间为平均11个月，平均术后分指幅度为23。；7例指蹼高度正常，2例高于正常2～3mm；患指掌指关节、指间关节活动度未受显著影响；8例患儿手术瘢痕增生不明显，1例瘢痕增生显著，经处理后无明显改善。术后患指功能、外形满意，所有家长对手术效果均满意。结论完全单纯性并指分指手术较多，但绝大多数需要通过部分植皮达到创面闭合的目的。本方法采用带血管蒂掌背皮瓣转移重建指蹼治疗完全单纯性并指，其手术方法较为简单，手术要点易于掌握，手术时间较短，更为重要的是无需通过植皮进行创面覆盖，所有创面均直接缝合进行关闭，术后随访效果满意。因此我们认为该术式是治疗完全单纯性并指的一种有效方式。

Objective To explore the application of island dorsal flap in congenital syndactyly release. Methods From September 2011 to August 2013, 9 patients （6 males, 3 females） with simple syndactyly, were treated. There were complete （n = 7） and imcomplete （n = 2） syndactyly, Syndactyly release was performed and commissure reconstruction administrated with an island dorsal flap. Resurfacing distal digits was achieved with crossed ＂z＂ plastic flap. The incision was closed properly and no residual bare area required skin grafting. The hands were fixed with cast post-operation for 3 weeks. Results Nine syndactylies were released with dorsal flap and without additional skin grafting. The average operative duration was 1.2 hours. All flaps survived postoperatively. The mean follow-up period was 11 months. The average range of digit abduction was 23 degree. While the depths of commissures from 7 patients were the same as contralateral ones, the depths of web space in 2 patients were 2-3 mm higher than contralateral ones. The positive and passive movements of metatarsal phalangeal joint （MP） and proximal interphalangeal joint （PIP） in released digits were similar to contralateral ones. One patient suffered severe scar formation even after a 6- month treatment whereas another 8 had minimal scar formation. The functional and cosmetic outcomes of all hands were satisfactory for their parents. Conclusions This simple and effective technique may shorten operation time significantly and required no skin grafting. Therefore island dorsal flap is an ideal option for congenital syndactyly release under proper indications.