Ⅲ期掌腱膜挛缩手术治疗皮瓣设计方法的改良

The improvement of the flap design method for Stage Ⅲ of Dupuytren's contracture surgery treatment

目的探讨Ⅲ期掌腱膜挛缩手术治疗皮瓣设计方法的改良,减少手指损伤及避免植皮的可行性。方法 2009年3月至2015年3月以来,我科共治疗18例Ⅲ期掌腱膜挛缩症的患者,因挛缩严重不利于皮瓣的设计,故在设计皮瓣之前先经挛缩严重的关节横纹处顺皮纹小切口切断挛缩的腱膜,使挛缩手指尽可能伸直,手指伸直后设计连续＂Z＂型皮瓣,通过切除挛缩的掌腱膜,保留神经血管束,皮瓣交叉转移后修复创面,避免植皮。结果术后切口I期愈合,术后随访时间3~48月,平均24月,挛缩指能完全伸直,皮肤无挛缩,手指屈伸活动基本正常,无直线瘢痕,手指感觉及运动正常。结论Ⅲ期掌腱膜挛缩手术治疗时首先经皮小切口切断受累手指的挛缩腱膜,使皮瓣设计简化,提高修复效果,能尽可能的有效利用皮瓣转移修复创面,避免植皮。

Objective To explore the feasibility of the improvement of the flap design method for Stage Ⅲ of Dupuytren＇s contracture surgery treatment,and to avoid finger injury and skin graft. Methods During March 2009 and March 2015,18 cases of patients with stage Ⅲ Dupuytren＇s contracture were admitted to hospital. Because of the contracture is too severe to design the flap,therefore the contractual aponeurosis was cut off firstly along the dermatoglyph of the severe contracture joint horizontal stripes before the design of flap for the unbend the contracture fingers as far as possible. Following the fingers unbended,a continuous ＂Z＂flap was designed,the contracture of palmar aponeurosis was removed,the nerve and blood vessel was reserved,and the wounds were repaired by cross transfer to avoid skin grafts. Results All the wounds were healed primarily. The follow-up time was 3 to 48 months,average of 24 months. All the contracture fingers were able to extend completely. The skin had no contracture. The flexion activities of all the fingers were almost normal. There were no linear scar and the sensory and motor of fingers were normal. Conclusion In the stage Ⅲ Dupuytren＇s contracture surgery,the affected contracture aponeurosis is cut off through percataneous small incision will simplify the design of flap,improve the effect of repairement,make use of the flap to repair the wounds as effective as possible to avoid skin grafts.