趾背五边形皮瓣重建趾蹼治疗先天性并趾的疗效评价

EFFECTIVENESS OF DORSAL PENTAGONAL FLAP FOR RECONSTRUCTION OF THE WEB SPACE IN CONGENITAL TOE SYNDACTYLY

目的探讨采用趾背五边形皮瓣重建趾蹼治疗先天性并趾的临床疗效。方法回顾分析2009年1月-2014年6月,采用趾背五边形皮瓣重建趾蹼并获随访的先天性并趾患儿10例。男6例,女4例;年龄8个月～9岁,平均42个月;左足5例,右足4例;双足1例;共重建13处趾蹼。7例合并多趾畸形,1例合并短趾畸形。术后根据足趾功能及趾蹼外观、深度、坡度以及主观满意度评价手术效果。结果术后13个皮瓣均完全成活,切口Ⅰ期愈合。患儿均获随访,随访时间6～50个月,平均26个月。重建后趾蹼皮肤颜色、质地均与健侧趾蹼相似。其中9例单足患儿9处分趾后两足趾外展度达（42.879±3.703）°,与健侧（45.922±2.657）°比较,差异无统计学意义（t=—2.004,P=0.062）;重建趾蹼深度为（1.881±0.266）cm,与健侧（1.631±0.202）cm比较,差异有统计学意义（t=2.248,P=0.039）;重建趾蹼坡度为（42.733±3.421）°,与健侧（41.189±5.593）°比较,差异无统计学意义（t=0.707,P=0.490）。1例双足4处趾蹼重建者,左、右足重建后的趾蹼外观与正常趾蹼相似。结论采用趾背五边形皮瓣重建趾蹼治疗先天性并趾,术中无需植皮,手术操作相对简便,手术时间短,术后皮瓣成活率高;重建的趾蹼外观及足趾功能与正常足趾相似。

Objective To investigate the effectiveness of dorsal pentagonal flap for reconstruction of the web space in congenital toe syndactyly. Methods Between January 2009 and June 2014, 10 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal pentagonal flap. There were 6 boys and 4 girls with the average age of 42 months（range, 8 months to 9 years）. The congenital toe syndactyly located at the left foot in 5 cases, the right foot in 4 cases, and both feet in 1 case; 7 patients had polydactyly and 1 patient had brachydactylia. During followup, the toe function and web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness. Results All 13 flaps survived and incisions healed by first intention. Ten patients were followed up 6-50 months（mean, 26 months）. The skin color and texture in 13 reconstructed web spaces were close to normal web space. In 9 patients undergoing web spaces reconstruction of single foot, the abduction angle of toes was（42.879±3.703）° at the injured side, showing no significant difference when compared with the normal side [（45.922±2.657）°]（t= —2.004, P=0.062）; the web space depth was（1.881±0.266） cm at the injured side and was（1.631±0.202） cm at the normal side, showing significant difference（t=2.248, P=0.039）; and the web space gradient was（42.733±3.421）° at the injured side and was（41.189±5.593）° at the normal side, showing no significant difference（t=0.707, P=0.490）. The web space appearance, web space depth, and web space gradient were close to those of the normal web space in 1 patient undergoing bilateral web spaces reconstruction. Conclusion Web space reconstruction with dorsal pentagonal flap is easy to perform with reliable blood supply and low re-operated rate. The cosmetic and functional results are satisfactory.