近节指间关节严重屈曲挛缩畸形的显微外科治疗

目的探讨应用邻指皮瓣联合同指侧方带蒂皮瓣治疗手指近节指间关节严重屈曲挛缩畸形的临床疗效。方法 2008年10月-2011年2月,收治11例11指手指近节指间关节严重屈曲挛缩患者。男7例,女4例;年龄20～63岁,平均32.6岁。挤压伤及电锯伤7例,烧伤及爆炸伤3例,电击伤1例。指别:示指4例,中指2例,环指2例,小指3例。病程6～24个月,平均12.4个月。按照Stern等手指近节指间关节挛缩分型标准,均为Ⅲ型。术中切除瘢痕后,手指伸直掌侧皮肤软组织缺损范围3.0 cm×1.5 cm～5.0 cm×2.5 cm,均伴肌腱、神经、血管或指骨外露。采用大小为2.2 cm×1.8 cm～3.8 cm×2.5 cm的邻指皮瓣联合大小为1.5 cm×1.2 cm～2.5 cm×2.0 cm的患指侧方带蒂皮瓣移位修复,其中3例采用2个指侧方带蒂皮瓣。供区植皮或直接拉拢缝合。结果术后皮瓣及植皮均成活,创面Ⅰ期愈合。患者均获随访,随访时间6～18个月,平均11.3个月。患指外形恢复满意,皮瓣质地柔软,无明显色素沉着及瘢痕挛缩。患指均可完全伸直,患指主、被动屈伸活动恢复满意。末次随访时,近节指间关节最大伸直角度范围10～15°,按照中华医学会近节指间关节活动范围标准评定:优6例,良4例,可1例,优良率为90.9%。结论邻指皮瓣联合同指侧方带蒂皮瓣具有操作简便、修复面积大、术后外观及功能恢复满意的优点,是治疗手指近节指间关节严重屈曲挛缩畸形较理想方法之一。

Microsurgery for severe flexion contracture of proximal interphalangeal joint

Objective To investigate the clinical results of cross-nger ap combined with laterodigital pedicled skin ap for repair of severeffexion contracture of the proximal interphalangeal joint.Methods Between October 2008 and February 2011,11 patients(11 ngers) with severeffexion contracture of the proximal interphalangeal joint were treated with cross-nger ap combined with laterodigital pedicled skin ap.There were 7 males and 4 females,aged 20-63 years(mean,32.6 years).The causes of injury were crush or electric-saw injury in 7 cases,burn or explosive injury in 3 cases,and electrical injury in 1 case.The locations were the index nger in 4 cases,the middle nger in 2 cases,the ring nger in 2 cases,and the little nger in 3 cases.The mean disease duration was 12.4 months(range,6-24 months).All cases were rated as type III according to Stern classi cation standard.The volar tissue defect ranged from 3.0 cm × 1.5 cm to 5.0 cm × 2.5 cm,with exposed tendons,nerves,vessels,or bone after scar relaxation.The defects were repaired with cross-nger aps(2.2 cm × 1.8 cm to 3.8 cm × 2.5 cm) combined with laterodigital pedicled skin aps(1.5 cm × 1.2 cm to 2.5 cm × 2.0 cm).Double laterodigital pedicled skin aps were used in 3 cases.The ap donor site was sutured directly or repaired with the skin graft.Results All aps survived completely and wound healed by rst intention.The donor skin graft survived.All the patients were followed up 6-18 months(mean,11.3 months).The nger appearance was satisfactory.The aps had soft texture and good color in all cases.No obvious pigmentation or contraction was observed.The contracted ngers could extend completely with good activeffexion and extension motion.At last follow-up,theffextension of the proximal interphalangeal joint was 10-15°.Based on proximal interphalangeal joint motion standard of Chinese Medical Association for hand surgery,the results wereffexcellent in 6 cases,good in 4 cases,and fair in 1 case;theffexcellent and good rate was 90.9%.Conclusion It is an easy and simple therapy to cover wound area of severeffexion contracture of the proximal interphalangeal joint after scar relaxation using cross-nger ap combined with laterodigital pedicled skin ap,which can repair large defect and achieve good results in nger appearance and function.