同期移植足部多个皮瓣修复多指掌侧不同程度缺损的效果

张喆; 李木卫; 陈智颖; 黄少耿; 梁勇; 胡伟; 王江龙

doi:10.3760/cma.j.cn501225-20240514-00175

同期移植足部多个皮瓣修复多指掌侧不同程度缺损的效果

doi: 10.3760/cma.j.cn501225-20240514-00175

深圳市龙岗区第八人民医院（深圳市龙岗区骨科医院）手外科,深圳　　518116

基金项目:

龙岗区医学重点专科建设项目 440307240221533600176

2023年龙岗区医疗卫生科技计划项目 LGWJ2023-145

详细信息

通讯作者:
李木卫,Email：494995960@qq.com

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出版历程
- 收稿日期: 2024-05-14

Effects of simultaneous transplantation of multiple foot flaps in repairing defects of varying degrees on the palmar side of multiple fingers

Department of Hand Surgery, the Eighth People's Hospital of Longgang District (Longgang Orthopaedics Hospital of Shenzhen), Shenzhen 518116, China

Funds:

Longgang District Key Medical Specialty Construction Project 440307240221533600176

2023 Longgang District Medical and Health Science and Technology Project LGWJ2023-145

More Information

Corresponding author: Li Muwei, Email: 494995960@qq.com

摘要

摘要: 目的探讨同期移植足部多个皮瓣修复多指掌侧不同程度缺损的效果。方法该研究为回顾性观察性研究。2020年2月—2023年3月,深圳市龙岗区骨科医院收治11例符合入选标准的多指掌侧缺损的23~52岁患者（38个患指）,其中男8例（31个患指）、女3例（7个患指）。患指均伴有皮肤软组织缺损、指骨/肌腱等深部组织外露,且2个拇指伴有甲床及末节指骨缺损。单指缺损面积为1.5 cm×1.0 cm~5.5 cm×3.0 cm。根据手指缺损面积及深度设计足部皮瓣,同期移植足部多个皮瓣修复各指创面,单个皮瓣切取面积为2.0 cm×1.0 cm~5.5 cm×3.0 cm。将皮瓣供区创面直接拉拢缝合或应用人工真皮/中厚皮片移植覆盖。统计皮瓣切取情况及修复患指数、手术时长,术后观察皮瓣成活情况、足部供区创面愈合情况,随访观察皮瓣情况及供受区恢复情况。末次随访时,参照中华医学会手外科学会拇、手指再造功能评定试用标准评定患指功能恢复情况,采用英国医学研究会感觉功能评定标准评定皮瓣感觉功能,采用寒冷不耐受症状严重程度量表评估患手耐受寒冷情况,采用温哥华瘢痕量表（VSS）评定皮瓣受区及供区瘢痕情况,采用Maryland足部评分标准评估供瓣足功能恢复情况。结果共从16只足上选择供区,单足切取2~4个皮瓣,应用游离足趾侧方皮瓣修复27个患指皮肤软组织缺损,应用游离足内侧皮瓣修复9个患指皮肤软组织缺损,应用游离𧿹趾甲骨皮瓣修复2个患指皮肤软组织缺损伴指骨缺损。手术时长为5.60~9.25 h。术后,患指移植皮瓣均成活,足部供区创面均愈合。随访12~25个月显示,皮瓣外观、色泽、质地与周围正常皮肤相近,患指指腹处饱满且指端痛、触觉恢复,足部供区无疼痛,患者行走不受影响。末次随访时,36个患指功能恢复情况为优,2个患指功能恢复情况为良；皮瓣感觉功能评级为S3~S4；患手均对寒冷轻度不耐受；皮瓣受区瘢痕VSS评分为1~3分,皮瓣供区瘢痕VSS评分为1~5分；供瓣足功能恢复情况均为优。结论同期移植足部多个皮瓣修复多指掌侧不同程度缺损是切实有效的治疗方法,术后患指外观及功能恢复良好,供区损伤小。
- 创伤和损伤 /
- 足 /
- 指 /
- 外科皮瓣 /
- 显微外科手术 /
- 游离皮瓣 /
- 创面修复
Abstract: Objective To explore the effects of simultaneous transplantation of multiple foot flaps in repairing defects of varying degrees on the palmar side of multiple fingers. Methods This study was a retrospective observational study. From February 2020 to March 2023, 11 patients aged 23-52 years with defects on the palmar side of multiple fingers (with 38 affected fingers) meeting the inclusion criteria were hospitalized at Longgang Orthopedics Hospital of Shenzhen, including 8 males (with 31 affected fingers) and 3 females (with 7 affected fingers). All affected fingers sustained skin and soft tissue defects, along with exposed deep tissue such as finger bones and tendons, and 2 thumbs exhibited nail bed and distal phalanx defects. The defect area of each finger ranged from 1.5 cm×1.0 cm to 5.5 cm×3.0 cm. Foot flaps were designed based on the area and depth of the finger defects, and multiple foot flaps were transplanted simultaneously to repair the wounds of fingers. The area of single flap resected ranged from 2.0 cm×1.0 cm to 5.5 cm×3.0 cm. Donor site wounds were closed directly or covered using artificial dermis or split-thickness skin grafts. The number of resected flaps, the number of affected fingers repaired, and the surgical duration were recorded. The flap survival and foot donor site wound healing were observed postoperatively. The flap and donor and recipient sites recovery were observed during follow-up. At the final follow-up, the functional recovery of affected fingers was evaluated based on the trial criteria of the Chinese Medical Association's Hand Surgery Society for function evaluation of thumb and finger reconstruction, the sensory function of the flaps was assessed by the sensory function evaluation standard of the British Medical Research Council, the cold tolerance of the affected hands was evaluated with the Cold Intolerance Severity Scale, the scars at the recipient and donor sites were assessed using the Vancouver scar scale (VSS), and the function recovery of flap donor foot was evaluated with the Maryland Foot Score criteria. Results Donor sites were selected from 16 feet with 2-4 flaps harvested from each foot. Specifically, skin and soft tissue defects in 27 affected fingers were repaired using free lateral toe flaps, skin and soft tissue defects in 9 affected fingers were repaired using free medial foot flaps, and skin and soft tissue defects with finger bone defects in 2 affected fingers were repaired using free toenail osteocutaneous flaps. The surgical duration ranged from 5.60 to 9.25 hours. Postoperatively, all transplanted flaps in affected fingers survived, and all foot donor site wounds healed. Follow-up for 12-25 months showed that the appearance, color, and texture of the flaps were similar to the surrounding normal skin. The affected finger pulp was full with the fingertip having restored pain and touch sensation. There was no pain in the donor site of foot, and the walking ability of patients was not affected. At the final follow-up, the functional recovery was evaluated as excellent for 36 affected fingers and good for 2 affected fingers. The sensory function rating of the flaps was graded as S3-S4, and all affected fingers were mild intolerant to cold. VSS scores of the scars at the recipient sites ranged from 1-3, and VSS scores of the scars at the donor sites ranged from 1-5. The functional recovery of all flap donor feet was excellent. Conclusions Simultaneous transplantation of multiple foot flaps is an effective treatment method for repairing defects of varying degrees on the palmar side of multiple fingers, resulting in excellent aesthetic and functional recovery of the affected fingers while causing minimal damage to the donor site.
- Wounds and injuries /
- Foot /
- Fingers /
- Surgical flaps /
- Microsurgery /
- Free flap /
- Wound repair
张喆：设计和实施手术、采集资料、数据整理以及撰写文章；李木卫：研究指导、设计和实施手术、论文修改；陈智颖、黄少耿、梁勇、胡伟、王江龙：实施手术、采集资料、分析数据

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图 1 同期移植双足多个皮瓣修复双手多指皮肤软组织缺损及右拇指末节指骨缺损的效果。1A、1B.分别为术前左、右手,双手拇、中、环、小指缺损；1C.双足部皮瓣设计情况；1D、1E.分别为术中右足4个皮瓣（1个右足第1趾腓侧皮瓣、1个右足第2趾胫侧皮瓣、2个右足底内侧皮瓣）、左足3个皮瓣（1个左足𧿹趾甲骨皮瓣、左足第2趾侧方皮瓣分裂成的2个皮瓣）切取完成并放置于对应受区近侧；1F、1G.分别为左手4个、右手3个皮瓣同期移植后即刻；1H、1I.分别为术中左足供区缝合、人工真皮覆盖后即刻；1J、1K.分别为术中右足供区缝合、人工真皮覆盖后即刻；1L.术后2年,双足供区仅左足第1趾无趾甲,余足趾及足部外形良好；1M、1N.分别为术后2年双手皮瓣掌侧、背侧观,外形较佳；1O、1P.分别为术后2年双手主动屈曲、对指活动情况,功能良好

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