保留展肌的改良游离足底内侧皮瓣修复手掌部瘢痕挛缩畸形
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摘要
目的探讨保留展肌的改良足底内侧游离皮瓣修复手掌部瘢痕挛缩畸形的疗效。方法 2012年1月—2017年7月,采用保留展肌的改良足底内侧游离皮瓣修复手掌部瘢痕挛缩畸形9例。其中男7例,女2例;年龄15～40岁,中位年龄23岁。瘢痕挛缩持续时间4～23年,平均9年。合并手关节僵硬3例,伴肌腱外露2例,肌腱合并神经外露2例。术中皮瓣切取范围为4.5 cm×4.0 cm～8.0 cm×6.0 cm。皮瓣血管蒂长7～8 cm,平均7.5 cm。供区取髂腹股沟全厚皮片植皮修复。结果术后皮瓣及植皮均顺利成活,创面均Ⅰ期愈合。9例患者均获随访,随访时间5～22个月,平均10个月。皮瓣外观平整,质地柔软,与周围正常皮肤相似。皮肤感觉恢复时间5～12个月,平均9个月。末次随访时,皮瓣感觉恢复为S_4级5例,S_3~+级2例,S_3级2例;两点辨别觉6.0～10.0 mm,平均8.5 mm。根据中华医学会手外科学会上肢部分功能评定试用标准评价,手功能获优5例,良2例,可2例。供足趾外展及屈曲活动均未受影响,植皮区稍有色素沉着。结论改良足底内侧游离皮瓣修复手掌部瘢痕挛缩畸形,不破坏展肌,供区损伤小,提高了植皮成活率,供足功能不受影响。
Objective To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm. Methods Between January 2012 and July 2017,a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old(range, 15-40 years). The duration of cicatricial contracture was 4-23 years(mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site. Results All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months(mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months(mean, 9 months). At last follow-up, the flap recovered to level S_4 in 5 cases, level S_3~+ in 2 cases, and level S_3 in 2 cases. The two-point discrimination was 6.0-10.0 mm(mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored. Conclusion The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot.
Objective To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm. Methods Between January 2012 and July 2017,a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old(range, 15-40 years). The duration of cicatricial contracture was 4-23 years(mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site. Results All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months(mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months(mean, 9 months). At last follow-up, the flap recovered to level S_4 in 5 cases, level S_3~+ in 2 cases, and level S_3 in 2 cases. The two-point discrimination was 6.0-10.0 mm(mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored. Conclusion The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot.
引文
1Boffeli TJ,Waverly BJ.Medial and lateral plantar artery angiosome rotational flaps for transmetatarsal and Lisfranc amputation in patients with compromised plantar tissue.J Foot Ankle Surg,2016,55(2):351-361.
2 金文虎,常树森,魏在荣,等.以足背动脉为蒂的跗内侧联合足底内侧游离皮瓣修复手掌部软组织缺损.中国修复重建外科杂志,2016,30(11):1379-1382.
3伍辉国,张文亚,江克罗,等.游离足内侧穿支皮瓣修复手掌侧皮肤软组织缺损七例.中华显微外科杂志,2014,37(2):173-175.
4 张字,高秋明,邓银栓,等.中外文献对足底内侧动脉分支描述差异的分析.中国临床解剖学杂志,2015,33(1):21-23.
5丛海波,余志平,丁英杰,等.游离足内侧皮瓣修复指掌侧皮肤缺损17例.中华显微外科杂志,2015,38(5):469-471.
6 王海文,顾荣,江新民,等.足底内侧动脉穿支皮瓣修复手部掌侧皮肤软组织缺损.中华显微外科杂志,2013,36(5):486-488.
7王守道,史增元,尹维刚,等.足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖.中国临床解剖学杂志,2014,32(4):381-383.
8 李丹,惠瑞,韩岩.足底内侧皮瓣游离移植修复足底创面.中华整形外科杂志,2017,33(3):196-199.
9Beidas OE,Tan BK,Petersen JD.The rotational advancement of medial plantar flap for coverage of foot defect:a case report.Microsurgery,2012,32(4):322-325.
10 孙广峰,吴祥奎,聂开瑜,等.游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损.中华手外科杂志,2017,33(4):245-247.
11Yang D,Yang JF,Morris SF,et al.Medial plantar artery perforator flap for soft-tissue reconstruction of the heel.Ann Plast Surg,2011,67(3):294-298.
12 Sato T,Ichioka S.Ostectomy and medial plantar artery flap reconstruction for charcot foot ulceration involving the midfoot.J Foot Ankle Surg,2016,55(3):628-632.
13吴春,谭莉,应建军,等.吻合浅静脉的足底内侧游离皮瓣修复手掌皮肤软组织缺损.中华手外科杂志,2017,33(3):230-231.
14 Tsai J,Liao HT,Ulusal BG,et al.Modified retrograde-flow medial plantar island flap for reconstruction of distal dorsal forefoot defects--two case reports.Microsurgery,2010,30(2):146-150.
15邹勇,邹文,刘容珍,等.扩大的足底内侧动脉皮瓣修复创伤性足跟软组织缺损.中华损伤与修复杂志(电子版),2014,9(5):40-42.
16 Jyoshid RB,Vardhan H,Anto F.Free medial plantar artery flap for the reconstruction of great toe pulp.J Plast Reconstr Aesthet Surg,2014,67(6):863-865.
17Oh SJ,Moon M,Cha J,et al.Weight-bearing plantar reconstruction using versatile medial plantar sensate flap.J Plast Reconstr Aesthet Surg,2010,64(2):248-254.
18 许亚军,周晓,柯尊山,等.不同穿支蒂足(底)内侧逆行岛状皮瓣修复前足底软组织缺损.中华显微外科杂志,2012,35(6):501-502.
19牟勇,黄东,邹小艳,等.吻合多穿支血管的足底内侧皮瓣修复手掌软组织缺损八例.中华显微外科杂志,2015,38(6):588-590.
20 Wu Z,Song D,Lin J,et al.Anatomic basis of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels:a cadaveric dissection.Surg Radiol Anat,2015,37(8):975-981.
2 金文虎,常树森,魏在荣,等.以足背动脉为蒂的跗内侧联合足底内侧游离皮瓣修复手掌部软组织缺损.中国修复重建外科杂志,2016,30(11):1379-1382.
3伍辉国,张文亚,江克罗,等.游离足内侧穿支皮瓣修复手掌侧皮肤软组织缺损七例.中华显微外科杂志,2014,37(2):173-175.
4 张字,高秋明,邓银栓,等.中外文献对足底内侧动脉分支描述差异的分析.中国临床解剖学杂志,2015,33(1):21-23.
5丛海波,余志平,丁英杰,等.游离足内侧皮瓣修复指掌侧皮肤缺损17例.中华显微外科杂志,2015,38(5):469-471.
6 王海文,顾荣,江新民,等.足底内侧动脉穿支皮瓣修复手部掌侧皮肤软组织缺损.中华显微外科杂志,2013,36(5):486-488.
7王守道,史增元,尹维刚,等.足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖.中国临床解剖学杂志,2014,32(4):381-383.
8 李丹,惠瑞,韩岩.足底内侧皮瓣游离移植修复足底创面.中华整形外科杂志,2017,33(3):196-199.
9Beidas OE,Tan BK,Petersen JD.The rotational advancement of medial plantar flap for coverage of foot defect:a case report.Microsurgery,2012,32(4):322-325.
10 孙广峰,吴祥奎,聂开瑜,等.游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损.中华手外科杂志,2017,33(4):245-247.
11Yang D,Yang JF,Morris SF,et al.Medial plantar artery perforator flap for soft-tissue reconstruction of the heel.Ann Plast Surg,2011,67(3):294-298.
12 Sato T,Ichioka S.Ostectomy and medial plantar artery flap reconstruction for charcot foot ulceration involving the midfoot.J Foot Ankle Surg,2016,55(3):628-632.
13吴春,谭莉,应建军,等.吻合浅静脉的足底内侧游离皮瓣修复手掌皮肤软组织缺损.中华手外科杂志,2017,33(3):230-231.
14 Tsai J,Liao HT,Ulusal BG,et al.Modified retrograde-flow medial plantar island flap for reconstruction of distal dorsal forefoot defects--two case reports.Microsurgery,2010,30(2):146-150.
15邹勇,邹文,刘容珍,等.扩大的足底内侧动脉皮瓣修复创伤性足跟软组织缺损.中华损伤与修复杂志(电子版),2014,9(5):40-42.
16 Jyoshid RB,Vardhan H,Anto F.Free medial plantar artery flap for the reconstruction of great toe pulp.J Plast Reconstr Aesthet Surg,2014,67(6):863-865.
17Oh SJ,Moon M,Cha J,et al.Weight-bearing plantar reconstruction using versatile medial plantar sensate flap.J Plast Reconstr Aesthet Surg,2010,64(2):248-254.
18 许亚军,周晓,柯尊山,等.不同穿支蒂足(底)内侧逆行岛状皮瓣修复前足底软组织缺损.中华显微外科杂志,2012,35(6):501-502.
19牟勇,黄东,邹小艳,等.吻合多穿支血管的足底内侧皮瓣修复手掌软组织缺损八例.中华显微外科杂志,2015,38(6):588-590.
20 Wu Z,Song D,Lin J,et al.Anatomic basis of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels:a cadaveric dissection.Surg Radiol Anat,2015,37(8):975-981.