足背六边形皮瓣在第4、5趾并趾伴小趾多趾畸形矫形中的应用

Application of dorsal foot hexagonal flap for reconstruction of web space in fourth and fifth toe syndactyly combined with polydactyly

目的探讨第4、5趾并趾伴小趾多趾畸形矫形中应用足背六边形皮瓣重建趾蹼的疗效。方法2016年5月—2019年10月收治第4、5趾并趾伴小趾多趾畸形27例(34足),其中男12例,女15例;年龄10个月~8岁,平均22.8个月。双足7例,单足20例。第4、5趾不完全并趾24足,完全并趾10足;小趾主干均存在不同程度的腓侧偏斜畸形。34足并趾分趾矫形后均应用足背六边形皮瓣一期重建趾蹼,切除胫侧多趾,同时采用关节面修整或楔形截骨矫正小趾腓侧偏斜。结果所有患儿创面均Ⅰ期闭合,均未植皮。术后27例患儿均获随访,随访时间6~36个月,平均18个月。足趾无屈曲挛缩,无明显瘢痕增生,趾蹼宽度和坡度正常。其中3例出现趾蹼爬移,其余趾蹼深度正常。所有患儿小趾腓侧偏斜均得到矫正,足趾屈曲功能良好,患儿家长均表示满意。结论应用足背六边形皮瓣重建趾蹼治疗第4、5趾并趾伴小趾多趾畸形,无需植皮,操作简便,皮瓣成活率高,足趾外观及功能良好,临床疗效满意。

Objective To explore the application of the dorsal foot hexagonal flap for reconstruction of the web space in the fourth and fifth toe syndactyly combined with polydactyly.Methods Between May 2016 and October 2019,27 patients(34 feet)with the fourth and fifth toe syndactyly combined with polydactyly were treated,including 12 males and 15 females with an average age of 22.8 months(range,10 months to 8 years).There were 7 bilateral feet and 20 unilateral foot.Twenty-four of which were incomplete and 10 were complete syndactyly of the fourth and fifth toes,and the fifth toes showed various degrees of fibular deflection.All the 34 feet were treated with one-stage reconstruction of the toe web with the dorsal foot hexagonal flap,and the correction of the fibular deviation of the fifth toe was made by removing the tibial polydactyly and using the articular surface dressing or wedge osteotomy.Results All wounds healed by first intention without skin-frafting.All patients were followed up 6-36 months(mean,18 months).There was no flexion contracture and obvious scar hyperplasia in all the patients,and the width and slope of the toe webs were normal.Three of the 34 webs developed web creep,and the rest of the toe webs were normal in depth.All 34 feet were corrected with peroneal fibular deviation,and the function of toe flexion was good.All parents of the children were satisfied with the outcome.Conclusion The reconstruction of toe webs with dorsal foot hexagonal flaps for the treatment of the fourth and fifth toes syndactyly combined with polydactyly requires no skin graft.The operation is simple with high survival rate of the flap,the appearance and function of the toes are good,and the effectiveness is satisfactory.