邻指皮瓣联合“Z”字成形术治疗严重屈曲畸形的掌腱膜挛缩症

Treatment of severe flexed malformation of Dupuytren's contracture with cross finger flap combined with Z shape plasty

目的探讨应用邻指皮瓣联合"Z"字成形术修复严重屈曲畸形的Ⅲ期以上掌腱膜挛缩症的手术方法和临床疗效。方法 2014年9月-2017年12月,对8例Ⅲ期以上严重屈曲畸形的掌腱膜挛缩症患者,通过设计连续的"Z"字皮瓣联合邻指皮瓣,切除挛缩掌腱膜,保留神经血管束,皮瓣交叉转移后修复缺损创面,邻指皮瓣供区行游离皮肤移植。结果术后8例皮瓣全部成活,随访10～48个月,无一例复发,皮瓣质地及外形满意。按中华医学会手外科学会上肢部分功能评定试用标准评定:患手运动功能优7例,良1例,优良率为100%。结论应用邻指皮瓣联合"Z"字成形术修复严重屈曲畸形的掌腱膜挛缩症,术后临床效果满意,是治疗严重屈曲畸形掌腱膜挛缩症的一种有效方法。

Objective To explore the surgical technique of applying the cross finger flap combined with Z shape plasty to repair the severe flexed malformation of Dupuytren’s contracture in Stage 3 and 4, and to evaluate the clinical effect. Methods From September 2014 to December 2017, 8 cases of the severe flexed malformation of Dupuytren’s contracture in Stage 3 and 4 were admitted to hosptial, a continuous Z flap was designed,the contracture of palmar aponeurosis was removed, the nerve and blood vessel was reserved, and the wounds were reaired by cross transfer, with skin grafting to cover the donor site of cross finger flap. Results All transfering flaps survived and all cases were followed-up for 10-48 months. All the patients have no relapse. The flaps appeared well with good texture. According to the upper limb functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Associatuion,the results were excellent in 5 cases, good in 1 case. The overall satisfactory rate was 100%. Conclusion Using cross finger flap combined with Z shape plasty to repair the severe flexed malformation of Dupuytren’s contracture has good clinical outcomes.It is an effective method for severe flexed malformation of Dupuytren’s contracture treatment in clinic.