腹部携带皮瓣在瘢痕性爪形手畸形修复中的应用

目的：探讨采用腹部携带皮瓣修复瘢痕性爪形手畸形的临床效果及其应用价值。方法：2003年9月—2007年9月,对8例11只手瘢痕性手部爪形畸形患者采用腹部携带皮瓣进行修复,Ⅰ期手术松解掌指关节的背屈畸形,腹部带蒂皮瓣覆盖;Ⅱ期手术松解指间关节屈曲畸形,在腹部皮瓣蒂部近端设计腹部携带皮瓣,依据指间关节创面设计皮瓣大小,断蒂后腹部携带皮瓣修复指间关节挛缩,恢复手部外形,后期加强康复锻炼。结果：术后7例患者腹部携带皮瓣血运良好,无皮瓣坏死或皮瓣危象,创面7～10d拆线;1例出现皮瓣远端小范围血运障碍,经换药后愈合。随访3～15个月,平均6个月,手部功能活动自如,无背屈或屈曲畸形,患者及家属满意。结论：采用腹部携带皮瓣可同时修复爪形手的掌指关节和指间关节屈曲畸形,减少了手术次数,手部功能可达到满意效果。该手术方法简单易行,值得推广。

Repair of claw hand due to scarring with an abdominal carrying skin flap

Objective:To evaluate the clinical effect of abdominal carrying skin flap in repairing claw hand due to scar and its value.Methods:From Septemher 2003 to September 2007,8 patients(11 hands)with scar claw hand were treated with abdominal carrying skin flap.At the fist stage,dorsiflexion deformity of metacarpophalangeal joints were treated with abdominal skin flap.At the second stage,flexion deformity of interphalangeal joints were loosened,and they were repaired with the abdominal carrying skin flap close to the pedicle of the flap,which was designed according to the size of the wound created by interphalangeal joints loosening.The shape of the claw hands was recovered after division of the pedicle.Active exercise was encouraged after surgery.Results:The abdominal carrying skin flaps survived in 7 patients without vascular crisis after operation.The suture was removed after 7-10 days.In one patient,signs of circulatory insufficiency were observed at the distal part of the flap,and it healed nicely after daily dressing.On 3-15 months follow-up(mean 6 months),the hand function was satisfactory without dorsiflexion deformity or flexion deformity,and the patients were satisfied with the operation results.Conclusion:The use of abdominal carrying skin flaps to repair dorsiflexion deformity of metacarpophalangeal joints and flexion deformity of interphalangeal joints at the same time gives a satisfactory result.This method is simple and can be popularized.