Chen Jianchong, Wu Zuhuang, Zhu Jianxian, Huang Yongxin, Xie Baogen
Department of Burn and Plastic Surgery, First Affiliated Hospital, Fuzhou General Hospital of Nanjing Military Region, Putian Fujian 351100, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Oct;25(10):1227-30.
To summarize the therapeutic effectiveness of incorporating pedicled retrograde flap of forearm transplantation for reconstructing severe contracture of the first web space and wrist.
Between November 2005 and February 2010, 26 patients with severe contracture of the first web and wrist were treated. There were 18 males and 8 females with an average age of 27 years (range, 12-45 years). The locations were the right sides in 15 cases and the left sides in 11 cases. The injury reason included hot water scald in 7 cases, explosion hurt in 5 cases, traffic accident in 3 cases, hot pressing in 5 cases, and flame burns in 6 cases. The duration of scar contracture ranged from 6 to 26 months with an average of 11 months. According to the evaluation standard by GU Yudong et al., all had severe contracture of the first web space, and concomitant injuries included adduction deformity thumb, limitation of the thumb extension and opposition function, and carpometacarpal flexion joint deformity. After scar contracture was released, the defect size ranged from 5.8 cm x 4.5 cm to 11.3 cm x 7.2 cm, which were repaired by the incorporating pedicled retrograde flap of forearm of 6.5 cm x 5.0 cm to 12.5 cm x 8.0 cm at size. The donor sites were directly sutured or repaired with skin graft.
Blister and partial necrosis occurred at the distal end of the flaps in 2 cases, which were cured after dressing change. The other flaps survived and wounds healed by first intention. Incisions at donor sites healed by first intention. Twenty-six patients were followed up 6 to 24 months (mean, 15 months). The patients had functional recovery in thumb adduction and opposition at different degrees. At 6 months after operation, according to the Swanson et al. AMA system for total thumb activity, the total thumb function was improved significantly, and according to Jensen et al. measurement, the width and angle of the first web space were significantly increased, all showing significant differences (P < 0.05).
Incorporating pedicled retrograde flap of forearm transplantation for repairing severe contracture of the first web space and wrist could augment the first web space and improve the wrist flexible function.
总结带蒂逆行前臂皮瓣移植修复第一掌指关节间隙及腕部重度挛缩的治疗效果。
2005年11月至2010年2月，收治26例第一掌指关节间隙及腕部重度挛缩患者。其中男18例，女8例，平均年龄27岁（12～45岁）。右侧15例，左侧11例。致伤原因：热水烫伤7例，爆炸伤5例，交通事故伤3例，热压伤5例，火焰烧伤6例。瘢痕挛缩时间6～26个月，平均11个月。参照顾玉东等的评定标准，均为第一掌指关节间隙重度挛缩，合并伤包括拇指内收畸形、拇指伸展及对掌功能受限、腕掌关节屈曲畸形。瘢痕挛缩松解后，缺损面积5.8 cm×4.5 cm～11.3 cm×7.2 cm，采用面积6.5 cm×5.0 cm～12.5 cm×8.0 cm的带蒂逆行前臂皮瓣修复。供区直接缝合或植皮修复。
2例皮瓣远端出现水疱及部分坏死，经换药后愈合。其余皮瓣成活，创面一期愈合。供区切口一期愈合。26例患者随访6～24个月，平均15个月。患者拇指内收及对掌功能均有不同程度恢复。术后6个月，按Swanson等的AMA系统评定拇指总活动度，拇指总功能明显改善；按Jensen等的测量方法，第一掌指关节间隙宽度及角度明显增加，差异均有统计学意义（P < 0.05）。
带蒂逆行前臂皮瓣移植修复第一掌指关节间隙及腕部重度挛缩，可增大第一掌指关节间隙，改善腕部屈伸功能。
