局部旋转皮瓣在手指掌侧跨关节皮肤软组织缺损中的应用

Application of local rotation flap in skin and soft tissue defects of metacarpophalangeal palmar transarticular area

目的介绍局部旋转皮瓣联合植皮术在手指掌侧跨关节皮肤软组织缺损中的应用效果。方法2015年5月-2017年10月,对10例手指掌侧跨越近指关节皮肤软组织缺损的患者,采用在创面两侧分别设计局部皮瓣,长宽比例控制在2∶1,将皮瓣对角旋转分解创面后植皮,术后观察创面愈合及手指的外形和功能恢复情况。结果 10例创面均Ⅰ期愈合,术后随访6～12个月,皮瓣质地与受区匹配,外观具有手指近指横纹,外形满意,植皮区无明显的色素沉着及挛缩,手指指间关节伸屈活动无明显受限。根据中华医学会手外科学会上肢部分功能评定试用标准评定:优8例,良2例。结论局部旋转皮瓣联合植皮术修复手指掌侧跨关节皮肤软组织缺损时,利用皮瓣再造手指的近指横纹,同时可减少因皮片挛缩而导致的掌侧皮肤张力,患指伸屈活动无紧绷感,提高了创面修复后的患指外观及患者满意度,为临床提供了一种安全、实用、简单的术式。

Objective To introduce the application of local rotating skin flap combined with skin grafting in the skin defect of metacarpophalangeal joint. Methods From May 2015 to October 2017, 10 cases of metacarpophalangeal palmar transarticular skin defect were treated with bilateral local skin flap respectively, length-width ratio control of 2 ∶1 separating flap diagonal rotating skin graft after wound,postoperative observation of wound healing and the shape of the fingers and function recovery was performed. Results All 10 cases obtained Ⅰ healing wound, postoperative follow-up of 6 to 12 months,the texture matched with the recipient area, and had the appearance of transverse lines of proximal phalanges of fingers, skin graft area had no obvious pigmentation and contracture, interphalangeal joint activities had no obvious limitation. According to the Chinese medical association hand surgery society upper limb partial function appraisal trial standard: excellent in 8 cases, good in 2 cases. Conclusion Local rotation flap combined with skin grafting to repair the skin defect of transarticular area can reduce the volar skin tension, caused by skin contracture, and improve the appearance of the wounded finger and patient’s satisfaction, It is a safe, simple, practical operation method.