分叶指背五边形皮瓣在并指分指术中的应用

Application of bilobed dorsal pentagonal flap in congenital syndactyly release

目的探讨分叶指背五边形皮瓣应用于并指分指术的近期疗效。方法对2018年1月至2019年10月温州医科大学附属第二医院育英儿童医院手外整形科应用分叶指背五边形皮瓣手术治疗的单侧单纯皮肤并指患儿15例临床资料进行回顾性分析。记录术后皮瓣坏死和创口感染等早期并发症发生情况;采用指蹼爬移Withey评分和瘢痕温哥华评分对患指术后外观进行评价;记录因手术并发症而需行再次手术情况;测量指蹼深度并与健侧进行比较;利用调查问卷评估患儿家长对术后效果满意度。结果15例患儿均获随访,平均随访时间14(12~20)个月。全部皮瓣均一期成活,术后未见皮瓣坏死和感染等并发症。无患儿因指蹼爬移或屈指挛缩需行再次手术。术后指蹼外形宽大,患侧指蹼深度与健侧差异无统计学意义。患儿家长对手术效果满意。结论应用分叶指背五边形皮瓣手术治疗并指畸形,可避免指蹼和指体掌侧线性瘢痕的形成,减少指蹼爬移和屈指挛缩的发生,近期疗效令人满意。

Objective To observe the effect of a bilobed dorsal pentagonal flap for congenital syndactyly release.Methods Clinical data of 15 children with congenital syndactyly released using the bilobed dorsal pentagonal flap in the Department of Hand and Plastic Surgery,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University between January 2018 and October 2019 were analyzed retrospectively.Early complications such as skin flap infection and necrosis were recorded.The web appearance was observed and evaluated by web creep.The web space depth was assessed and compared between the two sides.The scar contractures were evaluated and the secondary operation for web or scar contractures was recorded.The satisfaction of patients's parents was evaluated by questionnaire.Results All patients were followed up and the follow-up duration was 12-20 months(mean,14 months).No partial necrosis or complication was observed.There were no significant differences in web depth between the two sides.No secondary correction was required for web creep and scar contracture.All parents of the patients were satisfied with the results.Conclusion The application of the bilobed dorsal pentagonal flap in treatment of congenital syndactyly can avoid the linear palmar scar of the web and the finger,reduce the complication of web creep and scar contracture and obtain satisfactory short-term results.