足背双翼皮瓣在先天性并多趾畸形趾蹼重建中的应用

Application of foot dorsal double wing flap in the reconstruction of congenital polydactylism

目的探讨应用足背双翼皮瓣在先天性并多趾畸形趾蹼重建中的临床疗效。方法2014年9月-2018年2月对15例19趾先天性并多趾畸形患者进行并趾分离多趾切除治疗,于并趾近侧足背设计双翼皮瓣并向近端适当延长切口,利用趾蹼动脉供血向远端推进后与足底设计"锚"状切口缝合,于并趾掌背侧设计方向相反的"锯齿"状切口分离趾体,侧方创面适当修剪脂肪后直接缝合,不需要植皮。结果术后随访8~25个月,全部病例均未行植皮,术后1例皮瓣远端缝合过紧出现张力性水疱经拆线换药愈合,1例术后出现瘢痕增生,余皮瓣成活良好,趾蹼外形、坡度接近正常。依据Withey指蹼爬移分级评价趾蹼外观和高度,0级13例17趾;l级1例1趾;1例1趾趾蹼轻度上移。足趾的伸屈、收展活动和感觉按Swanson手功能评定标准评定,优13例17趾,良1例1趾,可1例1趾。结论采用足背双翼皮瓣治疗先天性并多趾畸形,可以达到Ⅰ期重建趾蹼、分离并趾、切除多趾且无需植皮的目的,手术时间短,临床疗效满意。

Objective To discuss the clinical effect of foot dorsal double wing flap on the toe web reconstruction of congenital polydactylism.Methods From September 2014 to February 2018,15 cases of19 feet with congenital polydactylism were treated by separation of syndactyly and removal of polydactyly,the dorsal double wing flap was designed at the proximal site of polydactyly,and extended the incision proximally,the flap pedicled with toe web artery was advanced to suture with the anchor incision in the plantar.The"saw"-shaped incision was designed reversly at the volar side,the toe was separated,the lateral wound was sutured directly after removing the fat without skin grafting.Results All cases were followed up for 8-25 months,no skin grafting was performed.1 case has tension blister caused by tight stitching,but healed after changing dressing,1 case had scar hyperplasm,others healed well,the appearance and slope were close to normal.According to Withey evaluation criteria,0 class in 13 cases of 17 toes,1 class in 1 case of 1 toe,1 case had slight moving up.The flexion and extension and sensation were evaluated according to Swanson criteria,excellent in 13 cases of 17 toes,good in 1 case of 1 toe,fair in 1 case of 1 toe.Conclusion The dorsal foot double wing flap can be used to treat congenital polydactyly and sydactyly,it can reconstruct toe web,separate sydatyly,remove polydactyly at the first stage without skin grafting,has the advantages of short operation time and satisfactory clinical effect.