摘要
目的探讨采用指动脉顺行筋膜瓣对WasselⅣ-D型复拇畸形行指体重建、美学修复的效果。方法 2014年6月—2017年3月,共收治12例WasselⅣ-D型复拇畸形患儿。其中男7例,女5例;年龄9～32个月,平均13.3个月。左侧8例,右侧4例。主拇甲床横径为健侧的70%～85%,平均75.3%;饱满度为健侧的50%～75%,平均62.4%。采用携带一侧指固有动脉的顺行筋膜瓣填充保留指桡侧甲侧襞并增加指体周径。末次随访时测算患侧指体周径相对于健侧的比例;采用日本手外科学会(JSSH)评分对所有重建拇指的外观及功能进行评价。结果手术均顺利完成,术后无感染、皮肤坏死等早期并发症发生。所有患儿均获随访,随访时间7～27个月,平均14.3个月。末次随访时指体无"Z"字样畸形,手术创面无明显瘢痕挛缩。重建拇指甲侧襞基本对称,指体周径达健侧的93%～96%,平均94.7%。JSSH评分为15～20分,平均17.9分;其中获优8例,良2例,中2例。结论采用指动脉顺行筋膜瓣对WasselⅣ-D型复拇畸形进行指体重建,指体细小及甲侧襞不对称均获得明显改善,能获得较好的美学修复。
Objective To explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication. Methods Twelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of9-32 months（mean, 13.3 months）. Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side（mean, 75.3%）. The degree of fullness was 50%-75% of the healthy side（mean,62.4%）. The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand（JSSH） scoring. Results All the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months（mean, 14.3 months）. At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry improved in all cases. The ratio of circumference of deformed finger to contralateral finger was 93%-96%（mean, 94.7%）. The JSSH score was 15-20（mean,17.9）; the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases. Conclusion The anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
作者
印飞
芮永军
薛明宇
林伟枫
刘帅
沈小芳
YIN Fei;RUI Yongjun;XUE Mingyu;LIN Weifeng;LIU Shuai;SHEN Xiaofang(Department of Pediatric Orthopaedics,Wuxi No.9 People＇s Hospital Affiliated to Soochow University,the Orthopaedic Hospital of Wuxi,Wuxi ]iangsu,214000,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第9期1201-1204,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
指动脉顺行筋膜瓣
复拇畸形
显微外科
Anterograde fascial flap of digital artery
thumb duplication
microsurgery
