游离旋髂浅动脉穿支皮瓣修复[母]甲瓣供区创面

Reconstruction of the donor site of hallux nail flap with free superficial circumflex iliac artery perforator flap

目的探讨游离旋髂浅动脉穿支皮瓣(SCIAPF)修复[母]甲瓣供区创面的疗效。方法从2015年12月至2022年12月,杭州整形医院手外三科对12例拇指外伤性缺损的患者行游离[母]甲瓣再造拇指,其中6例为拇指皮肤套状撕脱伤,骨支架和伸、屈肌腱完整;其余6例拇指缺损患者根据顾玉东分型法有3例为Ⅰ度缺损,2例为Ⅱ度缺损,1例为Ⅲ度缺损。均应用游离SCIAPF修复[母]甲瓣供区创面,切取皮瓣的大小为3.0 cm×6.5 cm~9.0 cm×7.0 cm。腹部供区直接缝合。术后通过门诊和(或)微信随访,根据中华医学会手外科学会上肢部分功能评定试用标准对再造拇指进行功能评定,根据Maryland足功能评定标准对供足进行功能评定。结果再造拇指全部成活。[母]甲瓣供区创面9例SCIAPFs顺利成活;本组有1例皮瓣出现静脉危象,予及时手术探查后成活;1例皮瓣尖端部分坏死,应用局部转移皮瓣消灭创面;1例皮瓣皮肤大部分坏死,基底成活,二期植皮修复创面。腹股沟供区11例一期愈合,遗留1条线状瘢痕;1例供区伤口内血肿,清除血肿后再次缝合而愈合。术后随访3~24个月,再造拇指按中华医学会手外科学会上肢部分功能评定试用标准,优10例,良2例;[母]趾保留原有长度,恢复正常的屈、伸功能。供足行走、跑步无疼痛。供足功能按Maryland足功能评定标准,优10例,良2例。SCIAPFs色泽、质地满意,其中5例偏臃肿,二期行皮瓣修整术。结论应用游离SCIAPF修复[母]甲瓣供区创面,能有效地保留供足的外观和功能,同时腹股沟供区瘢痕隐蔽,损伤小,符合皮瓣供区的选择要求。

Objective To investigate the efficacy of free superficial circumflex iliac artery perforator flap(SCIAPF)in reconstruction of the donor site of hallux nail flap.Methods From December 2015 to December 2022,Section Ⅲ of Department of Hand Surgery of Hangzhou Plastic Surgery Hospital conducted thumb reconstruction surgery with free hallax nail flaps for 12 patients with traumatic defects of thumbs.Six patients had degloving injuries of thumb with intact bone scaffold and extensor-flexor tendon.Among the other 6 patients with thumb defects,3 had grade I defect,2 had grade Ⅱ defect and 1 had grade Ⅲ defect,according to Gu Yudong's classification.Free SCIAPFs were used to reconstruct the donor sites of hallux nail flaps.Sizes of the flaps were 3.0 cm×6.5 cm-9.0 cm×7.0 cm.All donor sites in the abdomen were directly sutured.After surgery,functional evaluations of the reconstructed thumb were conducted through follow-ups at outpatient clinics and(or)by WeChat interviews,according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,and the functional evaluation of donor feet was conducted according to the Maryland foot function evaluation standard.Results Successful survival of the 9 cases of flap in the donor site of hallux nail flap.One patient had venous occlusion of flap and survived after timely surgical exploration.One flap had partial necrosis at the tip of flap,and the wound was eliminated with local transfer of a flap.One patient had necrosis over most of the flap with the base of the flap survived,and the wound was repaired by a stage-Ⅱ skin grafting.The donor sites at groin healed in stage-Ⅰ in all of 11 patients with a linear scar.One patient who had haematoma at the donor site was cured by removal of the haematoma and a re-suture.All the patients received a 3 to 24 months of postoperative follow-up.According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,10 patients were in excellent and 2 in good.All of the great toes remained with original length and recovered normal flexion and extension.No patient suffered pain while walking and running.According to the Maryland foot function evaluation standard,10 patients were in excellent and 2 in good.All SCIAPFs were satisfactory in colour and texture.Five patients had bloated flaps and underwent Hacks in the stage-Ⅱ.Conclusion Application of a free SCIAPF in reconstruction of the donor site for hallux nail flap can effectively preserve the appearance and function of the donor site.Meanwhile,the scar in the donor site of groin is concealed with little damage,therefore the groin meets the requirements as a donor site of a flap.