游离血流与神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩的效果

王凯; 金光哲; 滕志成; 葛成伟; 柳志锦; 巨积辉; 董帅; 王强; 李亚东

doi:10.3760/cma.j.cn501225-20220707-00286

游离血流与神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩的效果

doi: 10.3760/cma.j.cn501225-20220707-00286

苏州瑞华骨科医院手外科，苏州　　215104

基金项目:

苏州市医学重点学科 SZXK202127

详细信息

通讯作者:
金光哲，Email：jgz2020@suda.edu.cn

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出版历程
- 收稿日期: 2022-07-07

Effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint

Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202127

More Information

Corresponding author: Jin Guangzhe, Email: jgz2020@suda.edu.cn

摘要

摘要: 目的探讨采用游离血流、神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩的效果。方法采用回顾性观察性研究方法。2013年3月—2019年10月，苏州瑞华骨科医院收治9例符合入选标准的外伤术后近指间关节重度屈曲挛缩（Ⅲ型）患者，其中男5例、女4例，年龄17~62岁。切断影响近指间关节伸直的挛缩组织并切除瘢痕组织后，伸直位近指间关节掌侧创面大小为2.0 cm×1.0 cm~2.5 cm×1.5 cm，指固有动脉、神经缺损长1.0~1.5 cm。于第2趾胫侧切取与创面大小相同的皮瓣游离移植修复创面，用长约1.5 cm胫侧趾足底固有动脉、神经桥接修复缺损的指固有动脉、神经，于小腿近端胫侧切取全厚皮片修复皮瓣供区创面，将皮片供区创面直接缝合。术后观察皮瓣和皮片成活情况；随访患者并于末次随访时，观察患指与第2趾包括其上供受区恢复情况，同时观测皮瓣修复处及患指指腹两点辨别觉距离，对患指行Allen试验检查桥接血管血流通畅性，按照中华医学会近指间关节活动范围标准评价患指近指间关节功能。结果术后皮瓣和皮片均顺利成活。术后随访5~22个月，平均10个月。末次随访时，皮瓣修复处外形良好，色泽、质地佳，两点辨别觉距离为9~12 mm，患指指腹两点辨别觉距离为6~10 mm；患指Allen试验检查结果均为阴性（即桥接血管血流通畅性良好），无屈曲挛缩复发，近指间关节功能均评定为优；第2趾植皮区无破溃但伴少许色素沉着，足趾屈伸活动良好。结论采用游离血流、神经桥接型第2趾胫侧皮瓣治疗近指间关节重度屈曲挛缩，疗效可靠，皮瓣修复处色泽、质地佳，桥接修复挛缩严重的指固有动脉、神经有利于改善指体血供及重建感觉。
- 瘢痕 /
- 挛缩 /
- 手损伤 /
- 外科皮瓣 /
- 显微外科手术 /
- 指屈曲挛缩
Abstract: Objective To investigate the effects of tibial second toe free flap bridged with blood flow and nerve in the treatment of severe flexion contracture of the proximal interphalangeal joint. Methods A retrospective observational study was conducted. From March 2013 to October 2019, 9 patients with severe flexion contracture (type Ⅲ) of the proximal interphalangeal joint after trauma operation, conforming to the inclusion criteria, were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 5 males and 4 females, aged from 17 to 62 years. After the contracture tissue affecting the extension of the proximal interphalangeal joint was cut off, and the scar tissue was resected, the size of the volar wound near the proximal interphalangeal joint in extended position was 2.0 cm×1.0 cm-2.5 cm×1.5 cm, with the length of proper digital artery and nerve defect being 1.0-1.5 cm. A free flap of the same size as the wound was cut from the tibial side of the second toe and transplanted to repair the wound, and the defective proper digital artery and nerve was repaired by bridging with the tibial proper plantar digital artery and nerve of about 1.5 cm in length. The full-thickness skin graft was taken from the proximal tibial side of the lower leg to repair the wound at flap donor site. The wound at skin graft donor site was sutured directly. The survival of flap and skin graft was observed after operation. The patients were followed up, and at the last follow-up, the recovery of the affected finger and the second toe, including the donor and recipient areas were observed, the two-point discrimination distances of the flap repaired site and the pulp of the affected finger were observed and measured at the same time, the blood flow patency of bridged vessel of the affected finger was examined by Allen test, and the function of the proximal interphalangeal joint of the affected finger was evaluated according to Chinese Medical Association's standard for the range of motion of proximal interphalangeal joint. Results The flaps and skin grafts survived smoothly after operation. The follow-up after operation lasted for 5 to 22 months, with a mean of 10 months. At the last follow-up, the flap repaired site had good shape, good color and texture, with the two-point discrimination distance being 9-12 mm, and the two-point discrimination distance of the pulp of the affected finger was 6-10 mm; the Allen test results of the affected fingers were all negative (i.e., the bridged vessels had good blood flow patency), with no recurrence of flexion contracture, and the function of the proximal interphalangeal joint was evaluated as excellent; the skin graft area of the second toe was not ruptured but was a little pigmented, and the flexion and extension activities of toe were good. Conclusions The tibial second toe free flap bridged with blood flow and nerve has reliable therapeutic effect in the treatment of severe flexion contracture of the proximal interphalangeal joint, and the color and texture of the flap repaired area are good. Bridging to repair the severely contracted proper digital artery and nerve is beneficial to improve the blood supply of the finger body and rebuild the sensation.
- Cicatrix /
- Contracture /
- Hand injuries /
- Surgical flaps /
- Microsurgery /
- Flexion contracture of finger
王凯：酝酿和设计研究、实施手术、采集资料、分析数据以及撰写论文；金光哲、巨积辉：酝酿和设计研究、实施手术、修改文章与获取研究经费；滕志成、柳志锦、董帅、李亚东：实施手术、采集资料以及分析数据；葛成伟、王强：实施手术与采集资料

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参考文献(20)

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1 采用游离血流、神经桥接型左足第2趾胫侧皮瓣治疗例1压砸伤患者右环指离断再植术后近指间关节重度屈曲挛缩的效果。1A.右手第2~5指近节离断；1B.手指再植术后3个月复查，X线片显示骨折已愈合，右手第2~5指近节交叉克氏针存留；1C.手指再植术后半年，右环指近指间关节严重屈曲挛缩；1D.左足第2趾胫侧皮瓣设计；1E.右环指近指间关节挛缩松解后可完全伸直，将皮瓣游离后即刻；1F.皮瓣修复术毕即刻情况；1G.皮瓣修复术后半年随访，右环指伸指良好；1H.皮瓣修复术后半年随访，右环指屈指良好

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2 采用游离血流、神经桥接型右足第2趾胫侧皮瓣治疗例2碾压伤患者右环指创面拉拢缝合术后近指间关节重度屈曲挛缩的效果。2A.右手第2~5指掌侧严重皮肤软组织广泛挫裂伤；2B.创面拉拢缝合术后2个月复查，X线片显示骨折已愈合，右示指中节、中指和环指中近节克氏针存留，中指中节钢丝存留；2C.创面拉拢缝合术后10个月，右环指近指间关节严重屈曲挛缩；2D.右足第2趾胫侧皮瓣设计；2E.右环指近指间关节松解后可完全伸直，将皮瓣游离后即刻；2F.皮瓣修复术毕即刻情况；2G.皮瓣修复术后半年随访，右环指伸指良好；2H.皮瓣修复术后半年随访，右手可握拳

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