Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan.
Plast Reconstr Surg. 2010 Mar;125(3):963-8. doi: 10.1097/PRS.0b013e3181cb6743.
The dorsal rectangular flap technique has been widely used for the correction of syndactyly. In this method, however, the linear scar along the palmar border of the webspace may lead to secondary contracture and web creep. Some modifications have been advocated for breaking these linear scars. In this study, these modifications were evaluated biomechanically with the finite element method.
Based on computed tomography findings of seven adult hands, three scar models were created: the dorsal rectangular flap, the dorsal flap with palmar-based triangular flap, and the dorsal flap with V-shaped tip. Forced displacements were applied to mimic the hand-opening motion, and scar stresses and web displacement were investigated.
The maximal stress of the scar was significantly greater in the dorsal rectangular flap group than in the other groups (dorsal flap with palmar-based triangular flap, p = 0.046; dorsal flap with V-shaped tip, p = 0.018). The web was displaced most distally in the dorsal rectangular flap group compared with the other groups (dorsal flap with palmar-based triangular flap, p = 0.043; dorsal flap with V-shaped tip, p = 0.043). There was no significant difference between the dorsal flap with a palmar-based triangular flap group and the dorsal flap with a V-shaped tip group.
The authors' results indicate that both the palmar-based triangular flap and the V-shaped tip flap work well. It is strongly recommended that any break should be made in the palmar edge of the webspace for prevention of web creep.
背侧矩形皮瓣技术已广泛应用于并指畸形的矫正。然而，这种方法在手蹼的掌侧边缘会产生线性瘢痕，可能导致继发性挛缩和蹼爬行。一些改良方法被提倡用于打破这些线性瘢痕。本研究采用有限元法对这些改良方法进行了生物力学评估。
基于 7 只成人手的 CT 发现，创建了 3 种瘢痕模型：背侧矩形皮瓣、背侧带掌侧三角形皮瓣和背侧带 V 形尖端皮瓣。施加强制位移模拟手张开运动，研究瘢痕的应力和蹼的位移。
背侧矩形皮瓣组的瘢痕最大应力明显大于其他组（背侧带掌侧三角形皮瓣，p = 0.046；背侧带 V 形尖端皮瓣，p = 0.018）。与其他组相比，背侧矩形皮瓣组的蹼最远向移位（背侧带掌侧三角形皮瓣，p = 0.043；背侧带 V 形尖端皮瓣，p = 0.043）。背侧带掌侧三角形皮瓣组与背侧带 V 形尖端皮瓣组之间无显著差异。
作者的研究结果表明，掌侧三角形皮瓣和 V 形尖端皮瓣均效果良好。强烈建议在手蹼的掌侧边缘进行任何切开，以防止蹼爬行。
