皮瓣联合掌长肌腱折叠单排三点式固定治疗指背侧创面伴锤状指畸形的临床效果观察

Observation on the clinical effect of flap combined with palmaris longus tendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet finger deformity

目的探讨皮瓣联合掌长肌腱折叠单排三点式固定治疗手指末节背侧创面伴锤状指畸形的临床效果。方法2017年11月至2023年11月,苏州瑞华骨科医院手外科收治12例(12指)手指末节背侧创面伴锤状指畸形患者。男8例,女4例,年龄21~63岁。创面面积1.5 cm×1.0 cm~5.5 cm×2.0 cm。均采用皮瓣修复,其中1例采用带掌长肌腱的前臂静脉皮瓣,6例采用第2足趾侧方皮瓣,4例采用指背神经筋膜蒂皮瓣,1例采用游离腓浅动脉穿支皮瓣。术中扩创后均伴有肌腱缺损,均行掌长肌腱折叠单排三点式固定重建伸肌腱止点,并植入克氏针牵引指间关节。术后门诊定期随访,采用Crawford锤状指疗效评价体系评价手指功能恢复状况,采用皮瓣综合评价量表评定供受区恢复情况。结果本组12例患者治疗效果满意,创面均一期愈合。随访3~15个月,平均7个月。锤状指畸形均得到矫正,指间关节活动时无疼痛。Crawford锤状指疗效评价为优8例,良4例,优良率为100%。皮瓣综合评价量表评定为优9例,良3例,优良率为100%。皮瓣感觉恢复至S2~S3。其中静脉皮瓣有轻度色素沉着;腓浅动脉穿支皮瓣外观臃肿,经修薄后外观明显改善;其余皮瓣外观良好。供区均一期愈合,无功能障碍。结论采用皮瓣联合掌长肌腱折叠单排三点式固定治疗手指背侧创面伴锤状指畸形可取得较满意的临床效果。

Objective To explore the clinical effect of flap combined with palmaris longus tendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet finger deformity.Methods From November 2017 to November 2023,12 patients(12 fingers)with dorsal digital wound accompanied by mallet finger deformity were admitted to Hand Surgery Department of Suzhou Ruihua Orthopedic Hospital.There were 8 males and 4 females,aged from 21 to 63 years old.The wound areas ranged from 1.5 cm×1.0 cm to 5.5 cm×2.0 cm.All the wounds were repaired by the flaps,forearm venous flap with palmaris longus tendon was used in one patient,second toe lateral flaps were used in 6 patients,dorsal digital nerve fasciocutaneous pedicle flaps were used in 4 patients,and free superficial peroneal artery perforator flap was used in one patient.After intraoperative debridement,all patients had tendon defects.The extensor tendon insertion point was reconstructed by folding the palmaris longus tendon in a single-row three-point fixation,and Kirschner wires were implanted for the traction of the interphalangeal joint. Regular follow-up in theoutpatient department was conducted, and the Crawford mallet finger efficacy evaluation system was used toevaluate the recovery of finger function during the follow-up. The comprehensive evaluation scale for skin flapswas used to assess the condition of the donor area and recipient area. Results All the 12 patients weresatisfied with the treatment effect. The wounds healed in one stage. Patients were followed up for 3-15 months,with an average of 7 months. Mallet finger deformity had been corrected, and there was no pain duringinterphalangeal joint movement. According to the Crawford mallet finger efficacy evaluation system, 8 patientswere excellent and 4 patients were good, with an excellent and good rate of 100%. According to thecomprehensive evaluation scale for skin flaps, the results were rated as excellent in 9 patients and good in 3patients, with an excellent and good rate of 100%. The sensation of skin flaps restored to S2-S3. The venousflap had mild pigmentation, the superficial peroneal artery perforator flap had a bulky appearance, which wassignificantly improved after thinning. The remaining flaps had a good appearance, and the donor area healed inone stage without functional impairment. Conclusion The use of skin flap combined with palmaris longustendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet fingerdeformity can achieve good clinical results.