新型非对称背侧海鸥翼皮瓣在并指术后蹼状瘢痕挛缩治疗中的应用。

Utilization of a Newly Designed Asymmetric Dorsal Gull Wing Flap for the Treatment of Postoperative Web Creep After Syndactyly Surgery.

机构信息

From the Department of Burns and Plastic Surgery, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders; Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China.

出版信息

Ann Plast Surg. 2021 Nov 1;87(5):518-522. doi: 10.1097/SAP.0000000000002812.

DOI:10.1097/SAP.0000000000002812

PMID:33833154

Abstract

BACKGROUND

Web creep is the most common long-term complication requiring revision after syndactyly surgery; however, few methods have been reported. The aim of this study was to introduce a newly designed asymmetric dorsal gull wing flap to reconstruct web for the postoperative web creep.

METHODS

A retrospective analysis was performed for 20 patients from January 2016 to May 2019. Sex, age, original malformations, original surgical procedure, complications, time between the 2 operations, operation records, preoperative and postoperative photographs, and Withey score were reviewed.

RESULTS

Eleven boys and 9 girls with average age of 60.65 ± 44.76 months underwent revision. Twenty-nine web spaces were affected (web creep, 12 cases; web creep and scar contracture, 17 cases). The original surgical procedure consisted of syndactyly separation in 15 cases, syndactyly separation with a full-thickness skin graft in 5 cases. There was 1 case of postoperative infection. All patients received an asymmetric dorsal gull wing flap and a zigzag incision, 15 patients received an additional full-thickness skin graft. The average time interval between the 2 operations was 34.60 ± 35.94 months. The follow-up time was 34.30 ± 20.73 months. No complications were noted, none of the patients redeveloped web creep. The median values for web creep, flexion-extension deformity, total Withey scores in the postoperative period were significantly lower than the preoperative values. The appearance and function of all digits were good.

CONCLUSIONS

The asymmetric dorsal gull wing flap is a good choice for web reconstruction when web creep is caused by syndactyly surgery.

摘要

背景

蹼状粘连术后最常见的长期并发症需要进行修正，即发生皮瓣回缩，但目前鲜有相关方法报道。本研究旨在介绍一种新设计的背侧非对称海鸥翼皮瓣，用于修复术后皮瓣回缩导致的蹼状粘连。

方法

回顾性分析 2016 年 1 月至 2019 年 5 月收治的 20 例患者，分析患者的性别、年龄、原始畸形、原始手术方法、并发症、两次手术的间隔时间、手术记录、术前和术后照片以及 Withey 评分。

结果

11 例男性和 9 例女性，平均年龄 60.65±44.76 个月，均行手术修复。29 个蹼状间隙受累（皮瓣回缩 12 例，皮瓣回缩合并瘢痕挛缩 17 例）。原始手术方法包括 15 例并指分离，5 例并指分离联合全厚皮片移植。术后感染 1 例。所有患者均接受了背侧非对称海鸥翼皮瓣和锯齿状切口修复，15 例患者接受了额外的全厚皮片移植。两次手术的平均间隔时间为 34.60±35.94 个月。随访时间为 34.30±20.73 个月。无并发症发生，无患者出现皮瓣回缩复发。术后蹼状粘连、屈伸畸形、总 Withey 评分的中位数均显著低于术前。所有手指的外观和功能均良好。