足趾蹼三叶皮瓣修复相邻多指严重屈曲挛缩畸形六例

Repair of severe flexion contracture deformity of adjacent fingers with trifoliated flap from toe web in six patients

2014年5月-2018年1月,潍坊市益都中心医院收治6例相邻2指或3指掌侧瘢痕增生造成的严重屈曲挛缩畸形,其中男4例8指、女2例5指,年龄13~51岁。患指近侧指间关节屈曲60~90°,掌指关节屈曲60~80°,掌指关节、近侧指间关节、远侧指间关节的被动伸指度数之和为-180^-120°。瘢痕切除、肌腱松解伸直患指后均存在骨质和/或肌腱外露,创面面积4.0 cm×2.0 cm^8.5 cm×4.0 cm。采用趾腓侧皮瓣、第2趾趾腹皮瓣及跖底皮瓣组成的三叶皮瓣修复,皮瓣面积4.5 cm×2.5 cm^9.0 cm×4.5 cm。供区跖底创面直接缝合,残留创面采用大腿外侧全厚皮修复。本组患者创面全部愈合。术后皮瓣均成活,血运良好,无血管危象。随访6个月~2年,皮瓣外形较佳,不臃肿,色泽与周围皮肤相近,质地柔软,触觉、痛觉恢复可,两点辨别觉距离达6~8 mm;患指主、被动屈伸活动好;足部供区无功能障碍,仅遗留轻微瘢痕。本文说明足趾蹼三叶皮瓣是修复掌侧严重瘢痕增生所致手指严重屈曲畸形,特别是相邻2指或3指瘢痕增生切除松解后皮肤软组织缺损的较佳方法之一。

From May 2014 to January 2018,6 patients with severe flexion contracture deformity caused by palmar cicatricial hyperplasia of adjacent 2 or 3 fingers were admitted to the Yidu Central Hospital of Weifang.There were 4 males(8 fingers)and 2 females(5 fingers),aged 13-51 years.The degrees of flexion of proximal interphalangeal joint of affected fingers and metacarpophalangeal joint were respectively 60-90°and 60-80°,and the total degree of passive extension of metacarpophalangeal joint,proximal interphalangeal joint,and distal interphalangeal joint was from-180 to-120°.After scar resection,tendon release,and extension of affected fingers,bone and/or tendon were exposed,and the wound area was 4.0 cm×2.0 cm-8.5 cm×4.0 cm.The wound was repaired with trifoliated flap composed of fibular flap of great toe,abdominal flap of the second toe,and plantar metatarsal flap,with flap area of 4.5 cm×2.5 cm-9.0 cm×4.5 cm.The plantar metatarsal wound of the donor site was sutured directly,and the remaining wound was repaired with full-thickness skin graft from the outside of the thigh.All the wounds of patients were healed.All flaps survived and had good blood circulation without vascular crisis after operation.During follow-up of 6 months to 2 years,the flaps were with good appearance,no swelling,similar in color to the surrounding skin,soft in texture,good in sensations of touch and pain,and the distance of discrimination of 6-8 mm.The active and passive flexion and extension of the affected fingers were good,and there was no dysfunction in the donor site of foot,only with slight scar.The article showed that trifoliated flap from toe web is one of the best methods to repair the severe contracture flexion deformity of fingers caused by severe cicatricial hyperplasia of palmar side,especially the soft-tissue defect of the skin after the cicatricial hyperplasia of adjacent 2 or 3 fingers is removed.