同种异体脱细胞真皮在儿童完全并指术后甲襞不对称畸形修复中的应用效果

Application effect of allogeneic acellular dermal matrix in the repair of nail fold asymmetry deformity after complete syndactyly reconstruction in children

目的探讨同种异体脱细胞真皮在儿童完全并指术后甲襞不对称畸形修复中的临床应用效果。方法回顾性分析2022年1月至2023年12月南京医科大学附属儿童医院烧伤整形科收治的完全并指术后继发甲襞不对称畸形患儿的临床资料,患儿并指术后因手指远端分离侧软组织容量不足伴或不伴瘢痕挛缩导致甲襞不对称,需要行二期手术修复。术中沿指侧原手术瘢痕长轴设计Z形皮瓣并切开至侧甲襞近端,对瘢痕进行彻底松解,若局部瘢痕增生明显可同时行瘢痕减容术;从侧甲襞近端切口处皮下向指尖分离、形成隧道,将同种异体脱细胞真皮填充于隧道中,直至侧甲襞外观饱满,交叉缝合皮瓣关闭切口。术后定期对患儿手指切口愈合、瘢痕情况及外观进行随访观察,并根据Bulic的美学标准对指尖外观进行评价,分为优秀、良好、一般及较差4个等级。结果共纳入12例患儿,并指术后3~6个月出现甲襞不对称,其中男8例,女4例;年龄1~9岁,平均4.6岁;双手并指7例,单手并指5例,共累及38指;12例患儿共25指均存在远端容量不足,其中7例16指伴有瘢痕挛缩,指尖外观评价均为较差。12例患儿均顺利完成手术,其中1例在术后12 d拆除敷料时发现瘢痕皮瓣尖端坏死,经换药后愈合,其余患儿未发生感染及皮瓣坏死,切口均一期愈合。术后随访1~24个月,平均13.6个月,所有患儿手指侧甲襞软组织容量得到恢复,甲襞不对称畸形获得不同程度矫正,挛缩的瘢痕均完全松解。指尖外观评价:优秀4例7指,良好5例12指,一般2例4指,较差1例2指。结论在儿童完全并指术后继发甲襞不对称畸形修复中,应用同种异体脱细胞真皮进行填充可以有效恢复侧甲襞软组织容量,矫正甲襞不对称畸形,临床效果较好,且并发症少。

Objective To explore the clinical application effect of allogeneic acellular dermal matrix(ADM)in the repair of asymmetric nail fold deformity after complete syndactyly surgery in children.Methods A retrospective analysis was conducted on the clinical data of children with secondary asymmetric nail fold deformity after complete syndactyly surgery treated at the Department of Burn and Plastic Surgery,Children’s Hospital of Nanjing Medical University,from January 2022 to December 2023.The patients required a secondary surgical repair due to insufficient soft tissue capacity with or without scar contracture,causing asymmetry of the nail fold after finger separation at the distal end following syndactyly surgery.During the operation,continuous Z-plasty was designed along the original surgical scar axis and incised towards the proximal end of the lateral nail fold,followed by thorough scar release.Scar debulking surgery was performed if there was significant local scar hyperplasia.A tunnel was created from the incision site near the lateral nail fold to reach the fingertip subcutaneously.ADM was filled into this tunnel until a satisfactory appearance of the lateral nail fold was achieved.The flaps were then closed by cross-suturing.Regular follow-up observations were conducted on the incision healing,scar,and appearance of the finger,and aesthetic evaluation according to Bulic’s standards was performed,classifying them into four grades:excellent,good,fair,and poor.Results The study enrolled 12 patients,and nail fold asymmetry appeared 3 to 6 months after surgery,with 8 males and 4 females,ranging from 1 to 9 years old(average age 4.6 years).Affected digits included both hands in 7 cases and one hand in 5 cases,totaling 38 fingers.All 12 cases including 25 fingers presented with insufficient distal capacity in their fingers;seven cases including 16 fingers also had scar contracture resulting in poor appearance.All procedures were successfully performed.Post-operatively,one case of necrosis at the tip of the scar flap was observed after 12 days of removing the dressing but healed after dressing changes,and no infections or flap necrosis occurred in the remaining patients,with the incisions healing primarily.Follow-up periods ranged from 1 to 24 months,with an average duration of 13.6 months.All patients achieved the restoration of soft tissue capacity in the finger lateral nail fold,varying degrees of correction for asymmetrical nail fold deformities,and complete release for scar contracture,with 7 fingers in 4 cases rated as excellent,12 fingers in 5 cases as good,4 fingers in 2 cases as fair,and 2 fingers in one case as poor in evaluation of fingertip appearance.Conclusion The use of ADM for filling is effective in restoring soft tissue capacity and correcting asymmetrical deformities caused by secondary nail fold abnormalities after complete syndactyly repair surgery in children.It has shown good clinical outcomes with minimal complications.