摘要
目的探讨采用游离血流、神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩的效果。方法采用回顾性观察性研究方法。2013年3月—2019年10月,苏州瑞华骨科医院收治9例符合入选标准的外伤术后近指间关节重度屈曲挛缩(Ⅲ型)患者,其中男5例、女4例,年龄17~62岁。切断影响近指间关节伸直的挛缩组织并切除瘢痕组织后,伸直位近指间关节掌侧创面大小为2.0 cm×1.0 cm~2.5 cm×1.5 cm,指固有动脉、神经缺损长1.0~1.5 cm。于第2趾胫侧切取与创面大小相同的皮瓣游离移植修复创面,用长约1.5 cm胫侧趾足底固有动脉、神经桥接修复缺损的指固有动脉、神经,于小腿近端胫侧切取全厚皮片修复皮瓣供区创面,将皮片供区创面直接缝合。术后观察皮瓣和皮片成活情况;随访患者并于末次随访时,观察患指与第2趾包括其上供受区恢复情况,同时观测皮瓣修复处及患指指腹两点辨别觉距离,对患指行Allen试验检查桥接血管血流通畅性,按照中华医学会近指间关节活动范围标准评价患指近指间关节功能。结果术后皮瓣和皮片均顺利成活。术后随访5~22个月,平均10个月。末次随访时,皮瓣修复处外形良好,色泽、质地佳,两点辨别觉距离为9~12 mm,患指指腹两点辨别觉距离为6~10 mm;患指Allen试验检查结果均为阴性(即桥接血管血流通畅性良好),无屈曲挛缩复发,近指间关节功能均评定为优;第2趾植皮区无破溃但伴少许色素沉着,足趾屈伸活动良好。结论采用游离血流、神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩,疗效可靠,皮瓣修复处色泽、质地佳,桥接修复挛缩严重的指固有动脉、神经有利于改善指体血供及重建感觉。
Objective To investigate the effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint.Methods A retrospective observational study was conducted.From March 2013 to October 2019,9 patients with severe flexion contracture(typeⅢ)of the proximal interphalangeal joint after trauma operation,conforming to the inclusion criteria,were hospitalized in Suzhou Ruihua Orthopaedic Hospital,including 5 males and 4 females,aged from 17 to 62 years.After the contracture tissue affecting the extension of the proximal interphalangeal joint was cut off,and the scar tissue was resected,the size of the volar wound near the proximal interphalangeal joint in extended position was 2.0 cm×1.0 cm-2.5 cm×1.5 cm,with the length of proper digital artery and nerve defect being 1.0-1.5 cm.A free flap of the same size as the wound was cut from the tibial side of the second toe and transplanted to repair the wound,and the defective proper digital artery and nerve was repaired by bridging with the tibial proper plantar digital artery and nerve of about 1.5 cm in length.The full-thickness skin graft was taken from the proximal tibial side of the lower leg to repair the wound at flap donor site.The wound at skin graft donor site was sutured directly.The survival of flap and skin graft was observed after operation.The patients were followed up,and at the last follow-up,the recovery of the affected finger and the second toe,including the donor and recipient areas were observed,the two-point discrimination distances of the flap repaired site and the pulp of the affected finger were observed and measured at the same time,the blood flow patency of bridged vessel of the affected finger was examined by Allen test,and the function of the proximal interphalangeal joint of the affected finger was evaluated according to Chinese Medical Association's standard for the range of motion of proximal interphalangeal joint.Results The flaps and skin grafts survived
作者
王凯
金光哲
滕志成
葛成伟
柳志锦
巨积辉
董帅
王强
李亚东
Wang Kai;Jin Guangzhe;Teng Zhicheng;Ge Chengwei;Liu Zhijin;Ju Jihui;Dong Shuai;Wang Qiang;Li Yadong(Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital,Suzhou 215104,China)
出处
《中华烧伤与创面修复杂志》
CAS
CSCD
北大核心
2023年第8期765-770,共6页
Chinese Journal of Burns And Wounds
基金
苏州市医学重点学科(SZXK202127)。
关键词
瘢痕
挛缩
手损伤
外科皮瓣
显微外科手术
指屈曲挛缩
Cicatrix
Contracture
Hand injuries
Surgical flaps
Microsurgery
Flexion contracture of finger
