改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指畸形

改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指畸形

李甲1 裴广楠1 朱辉1 滕道练1 李海建1 郑大伟1 印飞2 寿奎水2

本文来源：《中华整形外科杂志》2023年2月第39卷第2期

DOI:10. 3760 / cma.j.cn114453-20221212-00381

作者单位：1徐州仁慈医院小儿骨科，徐州221000； 2苏州大学附属无锡九院小儿骨科，无锡214000

通信作者：朱辉，Email：zhuhuirenci@126.com

引用本文

李甲, 裴广楠, 朱辉, 等. 改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指畸形 [J] . 中华整形外科杂志, 2023, 39(3) : 273-277. DOI: 10.3760/cma.j.cn114453-20221212-00381.

【摘要】

目的探讨应用改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指畸形的临床效果。

方法回顾性分析2019年1月至2022年2月徐州仁慈医院小儿骨科采用改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指畸形患儿的临床资料。术中均存在分离并指后皮肤不足情况，选用足底内侧作为皮片移植供区。术后通过微信及门诊复查随访指蹼形态、手指外形、植皮区及足底内侧供皮区瘢痕挛缩程度，并采用改良Withey并指矫正评分评价手指、指蹼外观，并调查患儿家长满意度。

结果共纳入10例患儿，男5例，女5例，年龄1岁6个月~4岁，平均2岁10个月。术后随访6~18个月，平均11.3个月，所有患儿皮瓣及移植皮片均成活，创面均一期愈合；指蹼深度、宽度、坡度正常，移植皮片与周围皮肤无色差，手指外形美观，植皮区及足底内侧供皮区瘢痕不明显。改良Withey并指矫正评分为0~1分，平均为0.1分。患儿家长对手术效果均满意。

结论足底内侧皮肤与手部皮肤质地接近，改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指后，指蹼形态正常，手部外形美观，瘢痕不明显，且足底内侧供皮区比较隐蔽，不影响行走，术后可获得良好的功能和外形，是治疗皮肤不足的先天性并指畸形的有效方法之一。

【关键词】并指症；外科皮瓣；儿童；足底内侧；植皮

The investigation of modified double wing flap combined with medial plantar skin graft in the treatment of congenital syndactyly

Li Jia1, Pei Guangnan1, Zhu Hui1, Teng Daolian1, Li Haijian1, Zheng Dawei1, Yin Fei2, Shou Kuishui2

1Department of Pediatric Orthopaedics, Xuzhou Renci Hospital, Xuzhou 221000, China; 2Department of Pediatric Orthopaedics, Wuxi No.9 People’s Hospital Affiliated to Soochow University, Wuxi 214000, China

Corresponding author: Zhu Hui, Email: zhuhuirenci@126.com

【Abstract】

Objective To explore the clinical effect of the modified double wing flap combined with medial plantar skin graft in the treatment of congenital syndactyly.

Methods The data of children with congenital syndactyly treated by modified double wing flap combined with medial plantar skin graft in the Department of Pediatric Orthopaedics of Xuzhou Renci Hospital from January 2019 to February 2022 were retrospectively analyzed. All of them had skin deficiency after separating syndactyly during the operation. The medial plantar was selected as the skin graft donor area. The patients were followed up through WeChat and outpatient review after operations, the contents include the shape of finger web, the shape of finger, the degree of scar contracture in the skin graft area and the medial plantar skin donor area, and the appearance of finger web was evaluated by the modified Withey correction score, and investigate the satisfaction of parents of the children.

Results A total of 10 children were included, including 5 males and 5 females, aged 1 year and 6 months to 4 years, with an average age of 2 years and 10 months. There were 8 cases of middle ring finger syndactyly, 1 case of ring little finger syndactyly, and 1 case of index middle finger syndactyly. After separating syndactyly, the skin defect area is about 1.0 cm×1.5 cm-1.5 cm×3.0 cm, and a medial plantar full-thickness skin graft with the same area is taken. The postoperative follow-up was 6-18 months, with an average of 11.3 months. All the flaps and grafts survived, and the wounds healed in primary stage. The depth, width and slope of the finger web were normal, there was no color difference between the skin graft and the surrounding skin, and the appearance of the finger was beautiful. The scar in the skin graft area and the medial plantar skin donor area was not obvious. The modified Withey correction score was 0-1, with an average of 0.1. The parents were all satisfied.

Conclusion The texture of the medial plantar skin is similar to that of the hand. After the treatment of congenital syndactyly with the modified double wing flap combined with the medial plantar skin graft, the shape of the finger web is normal, the shape of the hand is beautiful, the scar is not obvious, and the medial plantar skin donor area is hidden, which does not affect walking. After the operation, good function and shape can be obtained. It is one of the effective method to treat congenital syndactyly with insufficient skin.

【Key words】Syndactyly; Surgical flaps; Child; Medial plantar; Skin graft

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Xuzhou Renci Hospital（XZRCLL-LW-202212001）

先天性并指畸形是常见的手部先天性畸形之一，除对于没有功能障碍的轻度不完全并指、全身状况较差、分指后可能进一步损伤原有功能的复杂性并指，手术需慎重评估外，多数并指畸形都需手术治疗[1]。自2014年田晓菲等[2]提出了应用双翼皮瓣治疗先天性并指畸形，并将其改良后[3]，徐州仁慈医院小儿骨科采用此种改良双翼皮瓣术式治疗先天性并指畸形，在术中有时会碰到分指后皮肤不足情况，我们采用足底内侧全厚皮片移植修复，取得了较满意的临床效果。

资料与方法

一、资料选择

回顾性分析2019年1月至2022年2月徐州仁慈医院小儿骨科采用改良双翼皮瓣联合足底内侧皮片移植治疗先天性并指畸形患儿的临床资料。纳入标准：(1)完全性并指分指后皮肤不足，需植皮覆盖创面；(2)患儿无其他基础疾病。排除标准：随访资料不全。

本研究经徐州仁慈医院医学伦理委员会批准(XZRCLL-LW-202212001)。所有患儿家长对本研究均知情同意并签署同意书。

二、方法

(一)手术方法

患儿取仰卧位。手术均采用全身麻醉+臂丛神经阻滞麻醉，上下肢分别应用气囊止血带。在手背并指指根部设计改良双翼皮瓣，并指掌侧基底设计奔驰标志形切口，并连的远端指体设计锯齿状切口。分开并指，修剪多余的脂肪组织。松止血带后止血，冲洗，将背侧的双翼皮瓣向掌侧推进，形成指蹼。缝合指侧方三角形皮瓣，测量皮肤缺损面积。于同侧或对侧足底内侧切取适当面积的皮肤，修剪为全厚皮片，移植覆盖指侧方残留创面，植皮区打包加压，足底内侧供皮区直接缝合。患儿指蹼间用无菌敷料隔开，绷带缠绕稍微加压包扎，包扎后指端漏出，便于血运观察。

(二)术后随访与疗效评价

术后通过微信及门诊复查进行随访，内容包括指蹼形态、手指外形、植皮区及足底内侧供皮区瘢痕挛缩程度、植皮区色素沉着情况。由术者采用改良Withey并指矫正评分评价手指指蹼外观[4](表1)。患儿家长进行满意度评价，对植皮区域瘢痕、指蹼外观、手指活动度、手指力量及供区瘢痕5个项目进行主观评分；每个项目满意2分，一般1分，不满意0分；总分0~10分，8~10分为满意，4~7分为一般，0~3分为不满意。