指动脉逆行岛状皮瓣术后供区瘢痕挛缩标准干预的有效性分析

Effectiveness analysis of standard intervention on scar contracture of donor site after reverse digital arteryislandflap surgery

目的探讨指动脉逆行岛状皮瓣术后标准预防供区瘢痕挛缩的有效性,为岛状皮瓣术后瘢痕的预防和治疗提供参考.方法自2017年1月至2020月年12月,我们对36例因指腹缺损行指动脉逆行岛状皮瓣修复的患者,术后随机分为对照组和治疗组,各18例.术后2周拆线后对照组仅接受常规的康复理疗,治疗组接受标准瘢痕预防治疗.所有患者分别在术后1、3、6、9、12个月随访.随访内容包括温哥华瘢痕量表评分、指蹼粘连情况、手功能评分及满意度评分.结果通过皮瓣供区瘢痕早期预防及治疗,明显改善供区瘢痕挛缩的发生.根据温哥华瘢痕量表评分,对照组最高12分、最低5分,治疗组最高8分、最低2分,治疗组瘢痕评分更低(P<0.001),瘢痕更小.治疗组指蹼粘连情况明显优于对照组(P=0.017).手功能按中华医学会手外科学会上肢部分功能评定试用标准评定:对照组优8例、良7例、可3例,治疗组优15例、良3例,治疗组手功能明显优于对照组(P=0.034).并且治疗组满意度评分(8.9±0.8)分,优于对照组(8.2±1.0)分(P=0.017).结论手部指动脉逆行岛状皮瓣供区术后早期进行瘢痕标准干预可有效预防瘢痕挛缩发生.

Objective To analyze the effectiveness of standard prevention of scar contracture in donor site after reverse digital artery island flap operation,and provide reference for the prevention and treatment of scar after island flap operation.Methods From January 2017 to December 2020,we randomly divided 36 patients who underwent reverse digital artery island flap repair due to finger pulp defect into control group and treatment group,18 patients in each group.After two weeks of suture removal,the control group received only routine rehabilitation physiotherapy,while the treatment group received standard scar prevention treatment.All the patients were followed up 1,3,6,9 and 12 months after operation.The follow-up included Vancouver Scar Scale,finger web adhesion,hand function score and satisfaction score.ResultsThe occurrence of scar contracture in the donor site was significantly improved by early prevention and treatment of scar in the donor site.According to the Vancouver Scar Scale,the highest score of the control group was 12,the lowest score was 5,and the highest score of the treatment group was 8,the lowest score was 2.The scar score of the treatment group was lower(P<0.001),and the scar was smaller.The finger web adhesion in the treatment group was significantly better than that in the control group(P=0.017).The hand function was evaluated according to the trial criteria of upper limb function evaluation issued by Hand Surgery Society of the Chinese Medical Association.The result of control group was excellent in 8 cases,good in 7 cases,fair in 3 cases,and that of the treatment group was excellent in 15 cases,good in 3 cases.The hand function of the treatment group was significantly better than that of the control group(P=0.034).The satisfaction of patients in the treatment group(8.9±0.8)was higher than that in the control group(8.2±1.0)(P=0.017).Conclusion The early standard intervention of scar can effectively prevent the occurrence of scar contracture in the donor site of hand reverse digital artery island flap.