摘要
目的探讨采用手指尺桡侧指固有动脉穿支皮瓣治疗患儿同指蹼状瘢痕挛缩的效果。方法2012年1月—2016年1月,笔者单位收治手指烧伤且经换药治疗后随生长发育致蹼状瘢痕挛缩患儿26例,共累及50指。患儿中男14例、女12例,年龄为2~14岁。切开松解瘢痕后,创面面积为1.6cm×1.0cm^5.0cm×2.6cm。采用同指尺桡侧指固有动脉穿支皮瓣修复创面,皮瓣面积为1.8cm×1.0cm^4.6cm×1.8cm;供瓣区直接拉拢缝合。供受区残余创面移植腹股沟区/邻近部位全厚皮片或邻近穿支皮瓣修复。随访观察术后手指发育情况及功能,采用中华医学会手外科学会上肢部分功能评定试用标准评定手指活动度,采用Kantor瘢痕美容评估与评级量表对手指瘢痕进行评分,记录末次数据。结果术后皮瓣及皮片均顺利成活。随访6~24个月,末次随访时,手指尺桡侧指固有动脉穿支皮瓣存活良好,颜色、质地较佳,皮瓣两点辨别觉距离为9~12mm;手指无挛缩,皮片移植区域少许色素沉着,手指无屈曲畸形且未向皮瓣切取侧弯曲,指蹼处无瘢痕挛缩;与健侧对比,手指发育无明显异常;手指活动度优38指、良12指,手指瘢痕评分2~3分31指、4~7分15指、8~10分4指。结论采用手指尺桡侧指固有动脉穿支皮瓣治疗患儿同指蹼状瘢痕挛缩疗效可靠,术后皮瓣成活率高,颜色、质地较佳,并发症较少,可避免术后手指短期内再次挛缩,并且不影响手指的生长发育。
Objective To explore the effect of the perforator flap of the proper digital artery on the ulnar or radial side of the finger in the treatment of webbed scar contracture of the same finger in child.Methods From January 2012 to January 2016,26 children who were treated with dressing change after burn of finger and then had webbed scar contracture along with growth and development were hospitalized in our unit,involving a total of 50 fingers.There were 14 males and 12 females among the children aged from 2 to 14 years.After the scar was dissected and released,the wound area ranged from 1.6 cm×1.0 cm to 5.0 cm×2.6 cm.The perforator flap of the proper digital artery of the ulnar or radial side of the same finger was used to repair the wound.The flap area ranged from 1.8 cm×1.0 cm to 4.6 cm×1.8 cm.The donor sites were sutured directly.The residual wounds in donor and recipient sites were repaired by full-thickness skin graft collected from inguinal area/adjacent area or adjacent perforator flap.The postoperative development and function of the fingers were followed up and observed.The range of motion of the fingers was evaluated according to the Chinese Medical Association Hand Surgery Society's upper limb functional evaluation trial standard,the Kantor Scar Cosmesis Assessment and Rating Scale was used to score the scar of finger,and the latest data were recorded.Results The flaps and skin grafts survived successfully after operation.The patients were followed up for 6 to 24 months.The perforator flaps of the proper digital artery on the ulnar or radial side of the finger survived well at the latest follow-up,with good color and texture and a two-point discrimination distance of 9 to 12 mm.There was no contracture of the fingers,a little pigmentation in the skin graft area,no flexion deformity of the fingers,no lateral bending of the fingers to the flap-harvesting side,and no scar contracture at the webs of the fingers.Compared with that of healthy side,the development of finger was not obviously abnormal.The range of motion of the fingers was excellent in 38 fingers and good in 12 fingers,and the scar score of the fingers was 2-3 points in 31 fingers,4-7 points in 15 fingers,and 8-10 points in 4 fingers.Conclusions The efficacy of perforator flap of the proper digital artery of the ulnar or radial side of finger in the treatment of the webbed scar contracture of the same finger in child is reliable,with high postoperative survival rate of the flap,better color and texture,and fewer complications,which can avoid the risk of re-contracture of the finger in a short period after operation,and does not affect the growth and development of the finger.
作者
常树森
何春念
唐修俊
张子阳
魏在荣
王达利
李海
龚飞宇
陈伟
Chang Shusen;He Chunnian;Tang Xiujun;Zhang Ziyang;Wei Zairong;Wang Dali;Li Hai;Gong Feiyu;Chen Wei(Department of Burns and Plastic Surgery,the Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2019年第5期356-361,共6页
Chinese Journal of Burns
基金
贵州省科技计划(黔科合[2016]支撑2910号)
汇川区科技计划[遵汇科合((2015)25号)。
关键词
瘢痕
外科皮瓣
儿童
指
穿支皮瓣
Cicatrix
Surgical flaps
Child
Fingers
Perforator flap
