足底内侧动脉穿支皮瓣移植整复手部掌侧瘢痕挛缩的效果

于玉芝; 董书男; 喻田; 江吉勇; 李孝根

doi:10.3760/cma.j.cn501225-20240726-00281

足底内侧动脉穿支皮瓣移植整复手部掌侧瘢痕挛缩的效果

doi: 10.3760/cma.j.cn501225-20240726-00281

1.
广州和平骨科医院手外科, 广州 510220
2.
北京积水潭医院贵州医院上肢修复重建外科, 贵阳 550014

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通讯作者:
董书男, Email：dong18585115275@163.com

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出版历程
- 收稿日期: 2024-07-26

Effects of medial plantar artery perforator flap transplantation in the reconstruction of palmar scar contracture

1.
Department of Hand Surgery, Guangzhou Peace Orthopedic Hospital, Guangzhou 510220, China
2.
Department of Upper Limb Repair and Reconstruction Surgery, Beijing Jishuitan Hospital Guizhou Branch, Guiyang 550014, China

More Information

Corresponding author: Dong Shunan, Email: dong18585115275@163.com

摘要

摘要: 目的探讨足底内侧动脉穿支皮瓣移植整复手部掌侧瘢痕挛缩的效果。方法该研究为回顾性观察性研究。2016年1月—2023年1月, 广州和平骨科医院收治15例符合入选标准的手部掌侧瘢痕挛缩患者, 其中男12例、女3例, 年龄15~50岁。术前患手功能密歇根大学手概况问卷调查表（MHQ）得分为58~77分, 患手总主动活动度为190~220°。患手掌侧瘢痕切除后皮肤软组织缺损面积为5.2 cm×3.2 cm~7.2 cm×6.0 cm。根据创面位置和面积, 采用足底内侧动脉浅支穿支皮瓣或足底内侧动脉浅支皮穿支、足底内侧动脉深支内侧支联体皮瓣修复创面, 皮瓣切取面积为5.5 cm×3.5 cm~7.5 cm×6.8 cm。足部供区创面采用旋髂浅动脉穿支皮瓣修复。术后观察足底内侧动脉穿支皮瓣和旋髂浅动脉穿支皮瓣成活情况。皮瓣成活后指导患者行患手康复锻炼。术后定期门诊随访, 观察足底内侧动脉穿支皮瓣外形、色泽、质地及足部功能恢复情况。末次随访时, 测定足底内侧动脉穿支皮瓣两点辨别觉距离, 采用中华医学会手外科学会上肢部分功能评定试用标准及MHQ对患手功能进行评估。结果术后2例患者足底内侧动脉穿支皮瓣出现血管危象, 经急诊探查后皮瓣成活；其余患者足底内侧动脉穿支皮瓣和旋髂浅动脉穿支皮瓣均成活。术后随访6~18个月, 足底内侧动脉穿支皮瓣外观不臃肿, 色泽、质地与周围皮肤接近；足部跑、跳功能未受影响。末次随访时, 足底内侧动脉穿支皮瓣两点辨别觉距离为7~10 mm, 平均8 mm；患手功能评定为优者12例、良者3例；患手功能MHQ得分为81~95分, 患者对术后患手外观、疼痛情况、功能恢复情况均满意。结论应用足底内侧动脉穿支皮瓣整复手部掌侧瘢痕挛缩, 皮瓣切取简便、成活率高, 术后皮瓣感觉及患手功能恢复好, 足部供区损伤小, 值得临床推广。
- 手 /
- 瘢痕 /
- 穿支皮瓣 /
- 足底内侧动脉 /
- 手外科
Abstract: Objective To investigate the effects of medial plantar artery perforator flap in the reconstruction of palmar scar contracture. Methods This study was a retrospective observational study. From January 2016 to January 2023, 15 patients with palmar scar contracture who met the inclusion criteria were admitted to Guangzhou Peace Orthopedic Hospital, including 12 males and 3 females, aged 15 to 50 years. Before surgery, the Michigan Hand Outcomes Questionnaire (MHQ) scores for the affected hands ranged from 58 to 77, and the total active motion for the affected hands ranged from 190° to 220°. The skin and soft tissue defect area after scar excision on the palmar side of the affected hands was 5.2 cm×3.2 cm to 7.2 cm×6.0 cm. According to the location and area of the wounds, the defects were repaired using either medial plantar artery superficial perforator flaps or combined flaps of the cutaneous perforator of superficial branch of medial plantar artery and medial branch of medial plantar artery deep branch. The area of the harvested flaps was 5.5 cm×3.5 cm to 7.5 cm×6.8 cm. The donor site wounds on the feet were repaired using superficial circumflex iliac artery perforator flaps. Postoperatively, the survivals of the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps were observed. After survival of the flaps, patients were guided for rehabilitation exercises for the affected hands. Regular outpatient follow-up was conducted after surgery to observe the appearance, color, and texture of the medial plantar artery perforator flaps, and the recovery of foot function. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap was measured, the function of the affected hands was evaluated using the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association and the MHQ. Results Postoperatively, two patients experienced vascular crisis of the medial plantar artery perforator flaps, while the flaps survived after emergency exploration; the medial plantar artery perforator flaps and superficial circumflex iliac artery perforator flaps survived in other patients. Follow-up for 6 to 18 months postoperatively showed that the medial plantar artery perforator flaps had no bulky appearance, similar color and texture to the surrounding skin, and the foot functions such as running and jumping were not affected. At the final follow-up, the two-point discrimination distance of the medial plantar artery perforator flap ranged from 7 to 10 mm, with an average of 8 mm; the affected hand function was rated as excellent in 12 cases and good in 3 cases; the MHQ scores of the affected hand function ranged from 81 to 95, and the patients were satisfied with the postoperative appearance, pain relief, and functional recovery of the affected hand. Conclusions The medial plantar artery perforator flap is used for the reconstruction of palmar scar contracture. The flap is easy to harvest, and has a high survival rate, resulting in good postoperative recovery of the flap sensation and function of the affected hand, and minimal donor site injury in the foot. It is therefore worthy of clinical promotion.
- Hand /
- Cicatrix /
- Perforator flap /
- Medial plantar artery /
- Hand surgery
本文亮点
(1) 证实足底内侧动脉穿支血管走行恒定、位置表浅, 术中可根据创面需要灵活设计皮瓣, 皮瓣切取不损伤足底内侧动脉主干血管, 不影响足部血运；皮瓣供区隐蔽, 且位于足部非负重区, 皮瓣切取后不影响足部功能。

(2) 证实足底内侧动脉穿支皮瓣与掌侧皮肤质地相近, 采用该皮瓣移植整复手部掌侧瘢痕挛缩, 术后患手外形、感觉、功能恢复良好, 患者满意度高。

利益冲突 所有作者声明不存在利益冲突

作者贡献声明 于玉芝：研究设计, 手术实施, 资料收集和整理, 论文撰写；董书男：论文修改, 提供研究经费；喻田、江吉勇、李孝根：手术实施, 研究设计和指导

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图 1 足底内侧动脉穿支皮瓣移植整复患者左手掌瘢痕挛缩的效果。1A.术前可见左手掌侧瘢痕挛缩, 左手中指、环指屈曲畸形；1B.术中切除左手掌侧瘢痕后；1C.术中切开足底内侧动脉穿支皮瓣, 显露足底内侧动脉浅支皮穿支、足底内侧动脉深支内侧支；1D.术中足底内侧动脉穿支皮瓣切取后；1E.术中将足底内侧动脉穿支皮瓣移植到左手掌后；1F、1G.分别为术中右侧旋髂浅动脉穿支皮瓣设计及切取后外观；1H.术中右侧旋髂浅动脉穿支皮瓣移植修复左足供区创面后；1I.术后1年随访时, 左手掌皮瓣外形不臃肿, 色泽接近正常手掌皮肤；1J.术后1年随访时, 左足供区移植的旋髂浅动脉穿支皮瓣外形美观

Figure 1. Effects of medial plantar artery perforator flap transplantation in the reconstruction of scar contracture on the left palm of a patient

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