摘要
目的探讨掌背连续十字形皮瓣成形指蹼结合掌侧多Z字皮瓣、瘢痕减容术治疗小儿多手指烫伤挛缩术后复发畸形的治疗效果.方法自2020年1月至2022年1月,我们共收治9例多手指烫伤挛缩术后指蹼变浅伴手指掌侧挛缩患儿,平均病程4.6年,手术均采用连续十字形皮瓣成形指蹼结合掌侧多Z字皮瓣、瘢痕减容修复创面,并结合规范的康复锻炼及抗瘢痕挛缩治疗.术后对患儿手功能和外观进行随访观察.结果术中均未行皮片移植,术后无皮瓣感染、坏死等并发症,9例患儿均获得随访,时间为8~32个月,平均22.4个月.所有患儿重建指蹼深度、宽度、坡度接近正常.温哥华瘢痕量表评分平均2.3分.根据总主动活动度(total active motion,TAM)手功能评定:优8例,良1例.改良Withey评分平均1.1分.结论连续十字形皮瓣成形指蹼结合掌侧多Z字皮瓣、瘢痕减容治疗多手指烫伤术后指蹼变浅伴手指掌侧挛缩畸形疗效确切,通过最大程度地利用掌背皮肤及保留瘢痕表面的皮肤来避免植皮,手术安全可靠,值得临床推广.
Objective To investigate the clinical efficacy of dorsal and palmar contiguous cross flaps in combination with palmar multiply Z-shaped flap and scar debulking in the treatment of recurrent deformity after operation of contracture in children with multiple fingers scald.Methods From January 2020 to January 2022,we treated 9 children with shallow finger webs and palmar contracture of fingers after operation for multiple fingers scald contracture,with an average course of 4.6 years.All the operations were performed with contiguous cross flaps in combination with palmar multiply Z-shaped flap and scar debulking to repair the wounds,and combined with standardized rehabilitation exercise and anti-scar contracture treatment.The function and appearance of children's hands were observed after operation.Results No skin graft was performed during the operation,and no complications such as skin flap infection and necrosis were found after the operation.All the 9 patients were follow-up for 8 to 32 months,with an average of 22.4 months.The depth,width and slope of reconstructed finger web in all children were close to normal.The average score of Vancouver Scar Scale was 2.3.According to the evaluation of total active motion(TAM)hand function,8 cases were excellent and 1 case was good.The average modified Withey score was 1.1.Conclusion The application of contiguous cross flaps in combination with palmar multiply Z-shaped flap and scar debulking has a definite effect on the treatment of palmar contracture deformity of fingers with shallowing finger webs after multi finger scald.Skin grafting can be avoided by maximizing the use of dorsal palmar skin and retaining the skin on the scar surface.The operation is safe and reliable,and it is worthy of clinical promotion.
作者
印飞
段玉来
顾珺
王军
林伟枫
Yin Fei;Duan Yulai;Guu Jun;Wang Jun;Lin Weifeng(Department of Pediatrie Orhopedics,Wuxi No.9 People's Hopial Afiliated to Suzhou University,Wuxi 214000,China;Minhe Hui and Tu Autonomous County People's Hospial,Haiedong 810800,China)
出处
《中华手外科杂志》
CSCD
北大核心
2023年第3期200-203,共4页
Chinese Journal of Hand Surgery
基金
海东市科技局东西部协作科研项目(2021-HDKJ-Y12)。
