应用改良第一趾蹼皮瓣修复重度虎口瘢痕挛缩

目的 探讨应用改良第一趾蹼皮瓣修复重度虎口瘢痕挛缩的方法,并进行临床评价.方法 2002年1月至2007年4月,对22例重度虎口瘢痕挛缩患者进行此手术.患者均表现为虎口瘢痕挛缩,拇指内收畸形,拇指外展及对掌功能明显受限,同时多伴有手背大面积瘢痕挛缩.在彻底切除虎口处瘢痕及粘连带后,设计改良第一趾蹼皮瓣修复虎口组织缺损,并用弓形针固定拇指于外展、对掌位.结果 本组22例术后皮瓣全部成活,1例远端皮瓣边缘坏死,经换药后愈合.随访12～24个月,平均17个月,虎口宽度平均增加35 mm,虎口角度平均增加57°,统计学分析结果显示,手术前后虎口角、虎口宽度差异均有统计学意义(P＜0.01),术后患侧虎口角、虎口宽度与健侧相比差异无统计学意义(P＞0.01).患侧两点辨别觉为6～9 mm,平均7 mm.供区植皮全部成活,无并发症出现,足部行走正常.结论 应用改良第一趾蹼皮瓣治疗重度虎口瘢痕挛缩,术后虎口外形、皮肤质地及功能均较满意,能恢复一定感觉,且供区位置隐蔽,是治疗重度虎口瘢痕挛缩的有效方法.

Reparation of severe traumatic thumb web contracture using modified free first toe web flap

Objective To study the methods of reparation of severe traumatic contracture of thumb web using modified free first toe web flap and make clinical evaluation.Methods From January 2002 to April 2007.22 patients with severe traumatic contracture of thumb web were repaired by modified free first toe web flap,after all the causes of contracture were eradicated and thumb web opened.The thumbs were fixed in abducens and opposite palm of hand position using an arch form pin.Results All 22 patients were followed up for 12 to 24 months(average 17 months)after operation.All of the flaps survived,however 1 case was partly necrosis but healed after change dressings.The width of thumb web space was augmented an average of 35 mm.and the angle of thumb web space was augmented an average of 57°.Statistical results showed that the difierence of width and angle of thumb web space both had statistically significant between the preoperative group and postoperative group.There was no statistically significant between postoperative group and the uninjured side.The two-point discrimination was 6-9 mm(average 7 am).The dermoplasty in donor side wag successful with no complications.All patients could walk normally.Conclusion Free tansplantation of first toe web flap in reparation of severe traumatic contracture of thumb web Can obtain good function and satisfactory outline and the donor site is concealment.This flap is a good method for the treatment of severe traumatic thumb web contracture.