掌背穿支皮瓣滑移术在并指畸形指蹼重建中的应用

The application of the dorsal metacarpal perforator sliding flap for web-space reconstruction in congenital syndactyly

目的 探讨掌背穿支皮瓣滑移术在先天性并指畸形指蹼重建中的应用.方法 在解剖学研究的基础上根据分指后指蹼皮肤缺损面积及创面形状,在手背相应掌骨间设计相应大小及形状的皮下穿支蒂掌背皮瓣（皮瓣四周切开而皮下不游离）,并于2007年5月至2012年11月,修复重建先天性并指畸形15例23侧28个指蹼.结果 28个皮瓣全部成活,皮瓣最大面积3 cm×2 cm,最小面积1.5 cm×1.0 cm.术后14例22侧26个皮瓣获10 ～22个月随访,平均14.5个月,患者指蹼大小适中,外形正常,掌指关节活动良好;指蹼两点辨距觉9～13 mm,平均11 mm.根据Swanson手功能的评定标准,对分指后的运动和感觉功能进行评定：优18个,良8个,可2个,优良率达92.6％.结论 掌背穿支皮瓣滑移术重建指蹼,具有手术简便安全、重建指蹼外形美观、功能好等优点,是先天性并指畸形指蹼重建的较好方法之一.

Objective To investigate the application of the dorsal metacarpal perforator sliding flap for web-space reconstruction in congenital syndactyly.Methods According to the size and shape of skin defect at the web space after division operation of syndactyly,the corresponding intermetacarpal perforator sliding flap was designed.The edge of the flap was cut off,but its underlying tissue was not dissected.From May 2007 to November 2012,28 web-spaces in 15 patients with syndactyly （10 male and 5 female） were reconstructed.Results All the 28 flaps survived completely.The flap size ranged from 3 cm ×2 cm to 1.5 cm×l.0 cm.14 cases with 26 flaps were followed up for 10-22 months （average,14.5 month）.The reconstructed web spaces had normal appearance and movement range.The 2-point discrimination distance was 9-13 mm（average,11 mm）.According to the Swanson Standard,18 fingers were graded as excellent,8 as good and 2 as fair （excellent and good,92.6％,26/28）.Conclusions Reconstruction of web-space in syndactyly with the dorsal metacarpal perforator flap has the advantages of easy handling,good cosmetic and functional results.