Luan Zhiyong, Liu Biao, Jiang Hongbo, Gao Fengqi, Yang Baogang
The Second Department of Surgery, Changchun Children's Hospital, Changchun, Jilin 130000, P.R. China.
Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China.
Oncol Lett. 2019 Sep;18(3):2384-2387. doi: 10.3892/ol.2019.10583. Epub 2019 Jul 5.
One case of epidermal granuloma of the right thumb was diagnosed by color Doppler ultrasonography and pathologic examination. Epidermal granuloma resection and reverse island skin flap transplantation were performed to determine the therapeutic effect of a reverse first dorsal metacarpal artery flap repair of an epidermal granuloma of the right thumb. After effective intravenous combined general anesthesia, the skin in the surgical field was disinfected and sterile drapes were placed. An oblique incision was made over the underlying epidermis granuloma. The right palm of the reverse first dorsal metacarpal artery flap was chosen. The pedicle was carefully protected, and the flap was transplanted to the defective skin area. The incision was sutured after hemostasis. A palpable mass with the dimension of the right thumb of the patient was measured by color Doppler ultrasonography and physical examination pre-operatively. The palpable mass was oval in shape and protruded from the skin surface. The palpable mass had an unclear boundary with the surrounding skin and therefore the skin should be removed. If the tendon is exposed after the resection, complications may occur after operation, such as skin necrosis and tendon exposure. Intra-operatively, the mass was 1.5×1.0 cm in size and multi-cystic. The boundary between the palpable mass and the surrounding skin could not be discerned. The skin area (1.5×1.0 cm in size) was completely invaded by the palpable mass, which was closely adhered to the surrounding tissue. The palpable mass was carefully dissected with appropriate protection to the finger nerves and arteries. The palpable mass and affected skin were completely removed, leaving a defect area of ~1.5 ×1.0 cm without skin. The reverse first dorsal metacarpal artery flap was used to repair the defect area. The repaired flap had a good blood supply and peripheral circulation. The operation was successful, and the anesthesia effect was satisfactory. Treatment of a thumb epidermis granuloma with reverse first dorsal metacarpal artery flap was shown to be a feasible strategy with a broad clinical application.
通过彩色多普勒超声检查和病理检查确诊1例右拇指表皮肉芽肿。行表皮肉芽肿切除术及逆行岛状皮瓣移植术，以确定逆行第一掌背动脉皮瓣修复右拇指表皮肉芽肿的治疗效果。在有效的静脉复合全身麻醉后，对手术区域皮肤进行消毒并铺无菌巾。在表皮肉芽肿下方做斜切口。选取右手掌逆行第一掌背动脉皮瓣，小心保护蒂部，将皮瓣移植至皮肤缺损区。止血后缝合切口。术前通过彩色多普勒超声检查和体格检查测量患者右拇指大小的可触及肿块。该可触及肿块呈椭圆形，从皮肤表面突出。可触及肿块与周围皮肤边界不清，因此应切除皮肤。如果切除后肌腱暴露，术后可能会出现皮肤坏死和肌腱外露等并发症。术中，肿块大小为1.5×1.0 cm，呈多囊性。可触及肿块与周围皮肤之间的边界无法辨认。大小为1.5×1.0 cm的皮肤区域完全被可触及肿块侵犯，肿块与周围组织紧密粘连。小心解剖可触及肿块，同时适当保护手指神经和动脉。将可触及肿块及受累皮肤完全切除，留下约1.5×1.0 cm无皮肤的缺损区。采用逆行第一掌背动脉皮瓣修复缺损区。修复后的皮瓣血供及外周循环良好。手术成功，麻醉效果满意。结果表明，逆行第一掌背动脉皮瓣治疗拇指表皮肉芽肿是一种可行的策略，具有广泛的临床应用前景。
