Chang S S, He C N, Tang X J, Zhang Z Y, Wei Z R, Wang D L, Li H, Gong F Y, Chen W
Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China.
Zhonghua Shao Shang Za Zhi. 2019 May 20;35(5):356-361. doi: 10.3760/cma.j.issn.1009-2587.2019.05.006.
To explore the effect of the perforator flap of the proper digital artery on the ulnar or radial side of the finger in the treatment of webbed scar contracture of the same finger in child. From January 2012 to January 2016, 26 children who were treated with dressing change after burn of finger and then had webbed scar contracture along with growth and development were hospitalized in our unit, involving a total of 50 fingers. There were 14 males and 12 females among the children aged from 2 to 14 years. After the scar was dissected and released, the wound area ranged from 1.6 cm×1.0 cm to 5.0 cm×2.6 cm. The perforator flap of the proper digital artery of the ulnar or radial side of the same finger was used to repair the wound. The flap area ranged from 1.8 cm×1.0 cm to 4.6 cm×1.8 cm. The donor sites were sutured directly. The residual wounds in donor and recipient sites were repaired by full-thickness skin graft collected from inguinal area/adjacent area or adjacent perforator flap. The postoperative development and function of the fingers were followed up and observed. The range of motion of the fingers was evaluated according to the Chinese Medical Association Hand Surgery Society's upper limb functional evaluation trial standard, the Kantor Scar Cosmesis Assessment and Rating Scale was used to score the scar of finger, and the latest data were recorded. The flaps and skin grafts survived successfully after operation. The patients were followed up for 6 to 24 months. The perforator flaps of the proper digital artery on the ulnar or radial side of the finger survived well at the latest follow-up, with good color and texture and a two-point discrimination distance of 9 to 12 mm. There was no contracture of the fingers, a little pigmentation in the skin graft area, no flexion deformity of the fingers, no lateral bending of the fingers to the flap-harvesting side, and no scar contracture at the webs of the fingers. Compared with that of healthy side, the development of finger was not obviously abnormal. The range of motion of the fingers was excellent in 38 fingers and good in 12 fingers, and the scar score of the fingers was 2-3 points in 31 fingers, 4-7 points in 15 fingers, and 8-10 points in 4 fingers. The efficacy of perforator flap of the proper digital artery of the ulnar or radial side of finger in the treatment of the webbed scar contracture of the same finger in child is reliable, with high postoperative survival rate of the flap, better color and texture, and fewer complications, which can avoid the risk of re-contracture of the finger in a short period after operation, and does not affect the growth and development of the finger.
探讨手指尺侧或桡侧指固有动脉穿支皮瓣在治疗儿童同一手指蹼状瘢痕挛缩中的应用效果。2012年1月至2016年1月，我科收治26例手指烧伤后换药，随生长发育出现同一手指蹼状瘢痕挛缩的患儿，共50指。患儿年龄2～14岁，男14例，女12例。瘢痕松解后创面面积为1.6 cm×1.0 cm～5.0 cm×2.6 cm。采用同一手指尺侧或桡侧指固有动脉穿支皮瓣修复创面，皮瓣面积为1.8 cm×1.0 cm～4.6 cm×1.8 cm。供区直接缝合，供区和受区残余创面采用腹股沟区/邻区全厚皮片或邻位穿支皮瓣修复。对手指术后发育及功能进行随访观察。依据中华医学会手外科学分会上肢功能评定试用标准对手指活动度进行评价，采用Kantor瘢痕美容评价量表对手指瘢痕进行评分并记录最新数据。术后皮瓣及植皮均顺利成活。患者随访6～24个月。末次随访时手指尺侧或桡侧指固有动脉穿支皮瓣成活良好，色泽、质地佳，两点辨别觉距离为9～12 mm。手指无挛缩，植皮区少许色素沉着，手指无屈曲畸形，无向皮瓣切取侧的侧弯，手指蹼间无瘢痕挛缩。与健侧相比，手指发育无明显异常。手指活动度优38指，良12指；手指瘢痕评分2～3分31指，4～7分15指，8～10分4指。手指尺侧或桡侧指固有动脉穿支皮瓣治疗儿童同一手指蹼状瘢痕挛缩疗效可靠，术后皮瓣成活率高，色泽、质地较好，并发症少，可避免术后短期内手指再次挛缩的风险，且不影响手指生长发育。
