筋膜瓣与带甲侧襞的靴形岛状瓣在WasselⅣ-D型复拇畸形修复中的应用

The fascial flap and shoe type neurovascular island flap with nail fold in Wassel Ⅳ-D thumb duplication reconstruction

目的探讨筋膜瓣及带甲侧襞的靴形岛状组织瓣在改善WasselⅣ-D型复拇术后保留指体细小及甲侧襞不对称外观的效果。方法2014年11月至2018年2月无锡市第九人民医院共手术治疗46例WasselⅣ-D型复拇畸形患儿,其中男31例,女15例,年龄5.5~24.0个月。根据尺侧主指内侧甲侧襞与外侧甲侧襞宽度的比值设计皮瓣:小于1/2时选择带甲侧襞的靴形神经血管岛状瓣,大于1/2时选择携带一侧指固有动脉的顺行筋膜瓣。术后随访时,于甲根部测量畸形指矫正后指腹周径,计算相对于健侧指腹周径的比例,并采用美学评分系统(ASS,总分18分),以及家长满意度(总分5分)对所有重建拇指进行评价。结果46例中以带甲侧襞的靴形神经血管岛状瓣修复30例,以携带一侧指固有动脉的顺行筋膜瓣修复16例,所有皮瓣无感染、坏死情况发生。术后随访10~37个月,平均19.3个月,所有患者重建拇指甲侧襞基本对称,指体周径占健侧比例为93%~103%;ASS评分38例为优(17~18分),8例为良(15~16分);家长满意度评分4~5分,平均4.83分。结论采用筋膜瓣与带甲侧襞的靴形岛状瓣对WasselⅣ-D型复拇畸形进行指体重建,可获得较好的指体周径及对称的甲侧襞外观,患者家属满意度较高。

Objective To explore the effect of using fascial flap and shoe type neurovascular island flap with nail fold in WasselⅣ-D thumb duplication reconstruction.Methods According to the ratio of the width of the nail fold on both sides of the finger,30 cases were treated with shoe type neurovascular island flap with nail fold(the ratio<1/2)and 16 cases with fascial flap(the ratio>1/2)between November 2014 to February 2018.The Aesthetic Scoring System(ASS)were proposed and parents’satisfaction scores were recorded to assess WasselⅣ-D thumb duplication reconstruction’s cosmetic results.Results All flaps survived.The average follow-up was 19.3 months(range,10 to 37 months).Nail fold symmetry was improved in all cases.Nail width and circumference were close to the normal side.38 cases were excellent and 8 cases were good based on the ASS.Parents’satisfaction scores range from 4 to 5,averaging 4.83 points.Conclusions The shoe type neurovascular island flap with nail fold and the fascial flap was a safe and effective approach to recovery the nail fold symmetry and reach the aesthetic improvement in WasselⅣ-D thumb duplication reconstruction.