Yin Fei, Rui Yongjun, Xue Mingyu, Lin Weifeng, Liu Shuai, Shen Xiaofang
Department of Pediatric Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000, P.R.China.
Department of Pediatric Orthopaedics, Wuxi No.9 People's Hospital Affiliated to Soochow University, the Orthopaedic Hospital of Wuxi, Wuxi Jiangsu, 214000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Sep 15;32(9):1201-1204. doi: 10.7507/1002-1892.201803014.
To explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication.
Twelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of abdominal circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring.
All the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry was improved in all cases. The ratio of abdominal circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases.
The anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
探讨指动脉顺行筋膜瓣在重建 WasselⅣ - D 型复拇指畸形中的有效性。
2014 年 6 月至 2017 年 3 月，采用指动脉顺行筋膜瓣治疗 12 例 WasselⅣ - D 型复拇指畸形患者。其中男 7 例，女 5 例，年龄 9 - 32 个月（平均 13.3 个月）。左侧 8 例，右侧 4 例。主要拇囊床宽度为健侧的 70% - 85%（平均 75.3%）。饱满度为健侧的 50% - 75%（平均 62.4%）。采用带一条固有指动脉的指动脉顺行筋膜瓣填充手指桡侧甲襞并增加手指周径。末次随访时，在指甲根部测量患指与对侧手指的腹围比值。采用日本手部外科学会（JSSH）评分法评估所有重建拇指的外观和功能。
所有手术均顺利完成，未出现感染、皮肤坏死等早期并发症。所有患儿均获随访 7 - 27 个月（平均 14.3 个月）。末次随访时，指体畸形无复发，手术切口瘢痕挛缩无明显变化。所有病例的指腹和甲襞对称性均得到改善。患指与对侧手指的腹围比值为 93% - 96%（平均 94.7%）。JSSH 评分为 15 - 20 分（平均 17.9 分）；其中优 8 例，良 2 例，可 2 例。
指动脉顺行筋膜瓣是一种安全有效的方法，可恢复 WasselⅣ - D 型复拇指畸形的对称性，改善美观。
