Elliot David, Giesen Thomas
Department of Hand Surgery, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom.
Indian J Plast Surg. 2013 May;46(2):325-32. doi: 10.4103/0970-0358.118611.
We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled 'What is secondary flexor tendon surgery'? This study concluded that 'secondary flexor tendon surgery' was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that 'any flap will do' provided the flexors are adequately covered.
我们最近在欧洲手部外科学会联合会报告了一项小型研究，其标题为“什么是二期屈肌腱手术？”。该研究得出结论，“二期屈肌腱手术”是一个涵盖多种病理情况的通用名称。10%至15%的病例表现出皮肤和皮下脂肪的病理改变，需要对这些组织进行皮瓣重建。皮肤替代可在一期手术时预防性使用，或在瘢痕挛缩松解后的二期手术时成为必要，以覆盖重要结构。与屈肌腱功能相关的皮肤缺损的长期问题之一是由于体表纵向瘢痕缩短导致的伸展功能丧失，即使屈肌腱主要负责手指的弯曲而非伸直。这种伸展功能丧失在手部只能在一定程度上被耐受而不导致明显的功能丧失。本文主要分析了适用于不同程度皮肤缺损以及屈肌系统行程中不同部位的皮瓣。它试图消除那种认为“只要屈肌得到充分覆盖，任何皮瓣都行”的观念。
