游离踇趾腓侧皮瓣移植修复儿童手部创伤性软组织缺损

Transplantation of free great toe fibular flap for repairing traumatic soft tissue defects of hands in children

目的 探讨游离踇趾腓侧皮瓣移植治疗儿童手部创伤性软组织缺损的疗效及其应用价值。方法 2013年7月至2018年4月对11例因机械外伤导致的手部软组织缺损患儿,采用游离踇趾腓侧皮瓣移植的方法修复创面。其中,男10例,女1例;年龄5~17岁,平均11.5岁;移植皮瓣面积最小3.0 cm×1.5 cm,最大5.5 cm×2.5 cm。将第一跖背动脉(或足背动脉)与桡动脉吻合,皮瓣供区创面用腹股沟全厚皮片游离植皮。结果 本组平均手术时间3.5 h,均吻合"一动两静",术后发生血管危象1例,及时手术探查,最终11例皮瓣均完全成活。3例出现皮瓣供区植皮坏死,经换药后痂下愈合。经平均10个月随访,皮瓣外形满意,色泽正常,弹性、质地良好,与受区周围组织基本一致。根据Michigan手功能评价,本组11例对外观均"非常满意";7例对伤指功能评价"非常满意",2例"满意",另有"不满意"和"非常不满意"各1例。皮瓣供区足趾运动功能无明显障碍。结论 在熟练掌握显微小血管吻合技术及重视儿童围手术期综合管理的基础上,游离踇趾腓侧皮瓣移植修复儿童手部软组织缺损取得满意疗效,受区美观,供区隐蔽,且手指及足趾功能良好,值得临床推广应用。

Objective To explore the efficacy and application value of free great toe fibular flap transplantation for traumatic soft tissue defect of hands in children.Methods From July 2013 to April 2018,11 children with hand soft tissue defects due to mechanical trauma were treated with free fibular flap.There were 10 boys and 1 girl with an average age of 11.5(5-17)years.The area of transplanted skin flaps was at 3.0 cm×1.5 cm the smallest and at 5.5 cm×2.5 cm the largest.The first dorsal metatarsal arteries(or dorsalis pedis)were anastomosed with radial arteries.Full-thickness inguinal skin was employed for free skin grafting at donor site of flaps.Results The average operative duration was 3.5 hours.One artery and two veins were anastomosed.Postoperative vascular crisis occurred in 1 case.Skin flaps survived after timely surgical exploration.And all flaps survived completely in 11 cases.Necrosis of skin graft occurred in 3 cases and there was subcrustal healing after dressing change.After an average follow-up period of 10 months,skin flaps were satisfactory in appearance,normal in color,excellent elasticity and texture and basically consistent with the surrounding tissues of recipient area.According to Michigan Hand Outcome Questionnaire,the outcomes were"very satisfied"with appearance(n=11),"very satisfied"with the function evaluation of injured fingers(n=7),"satisfied"(n=2),"unsatisfactory"(n=1)and"very unsatisfactory"(n=1).There was no obvious disturbance of toe motor function at donor site of flap.Conclusions On the basis of mastering microvascular anastomosis technique and paying attention to comprehensive managements of perioperative period of children,the transplantation of free great toe fibular flap for repairing soft tissue defect in hands has achieved satisfactory outcomes.The recipient area is aesthetic with concealed donor area and excellent functions of fingers and toes.It is worthy of wider clinical applications.