重度虎口挛缩的外科治疗探讨

目的：分析应用外科皮瓣修复虎口重度挛缩的临床疗效,探讨重度虎口挛缩的治疗与康复。方法：1995年8月-2006年12月,对31例重度虎口挛缩患者应用拇指指背皮瓣、前臂外侧皮神经营养血管为蒂的逆行岛状皮瓣,股前外侧皮瓣转移或移植的方法进行修复。结果：31例转移皮瓣及游离皮瓣全部成活,术后随访2～3年,原虎口挛缩畸形都得到了完全或接近正常的矫正,拇指捏握、外展、对掌功能有明显的改善,虎口外形良好,可完成拇指外展对掌功能。结论：以拇指指背皮瓣、前臂外侧皮神经营养血管为蒂的逆行岛状皮瓣、股前外侧皮瓣修复重度虎口挛缩,手术简便安全,损伤小,效果好。应根据患者损伤机制、局部软组织条件、虎口畸形程度选择适宜的手术方案。

The reason and therapy of severe thumb web contracture

Objective:To explore the clinical results of moderate and severe thumb web contracture treated with three types of flaps. Methods:31 patients were diagnosed as severe contractures of the thumb web space according to Sandzen and Yu-dong Gu's standard.10 cases were reconstructed with forearm island fasciocutaneous flap, and 17 cases were reconstructed with dorsal fasciocutaneous flap of thumb, and 4 cases were reconstructed with Anterolateral thigh flap.After operation curative effects were evaluated by measuring hands function and the thumb web space.All of the cases arise from August 1995 to December 2006 in our hospital. 31 cases were followed up for two to three years.Results:All of the flaps survived completely. The flap sensation was good and it had good appearance. The opposition function, abductor function ,and adductor function were normal.The function of the first metacarpophalangeal joint and treatment outcome were satisfactory.Conclusion:Treatment of thumb web contracture with flap is an effective and satisfactory outcomes. Severe contractures of thumb web space could beaugmented by the three types of flaps, however each technique has its advantages and disadvantages,so suitable project were selected depending on the state of the thumb,the possible presence of scar tissue and the extent of the thumb web deformity.