Xiao Shun'e, Zhang Tianhua, Wu Bihua, Li Hai, Wei Zairong, Wang Dali, Deng Chengliang
Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Feb 15;36(2):220-223. doi: 10.7507/1002-1892.202109065.
To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot.
Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly.
The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites.
The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.
探讨在浅筋膜下解剖的股外侧皮动脉穿支薄皮瓣修复手足瘢痕挛缩畸形的有效性。
2017年1月至2020年10月，收治15例手足瘢痕挛缩畸形患者。男9例，女6例；年龄6～42岁，中位年龄23岁。瘢痕挛缩时间1～21年，中位时间13年。手部瘢痕挛缩畸形11例，足部4例，均有不同程度的手足关节功能障碍。瘢痕挛缩松解后，创面大小为6 cm×4 cm至9 cm×8 cm，其中12例伴有血管、神经或肌腱外露，4例伴有肌腱缺损。采用在浅筋膜下解剖的股外侧皮动脉穿支薄皮瓣修复创面。皮瓣大小为6.0 cm×5.0 cm至10.0 cm×8.5 cm。采用筋膜条重建肌腱，供区直接缝合。
1例皮瓣发生静脉血管危象，经治疗后皮瓣成功存活。其余皮瓣存活良好，创面一期愈合。供区所有切口均一期愈合。所有患者术后随访6～12个月，平均9个月。皮瓣外形及质地良好。患手功能大部分恢复。根据中华医学会手外科学分会上肢功能评定标准，优7例，良4例。患足趾关节畸形明显改善。供区未发生肌肉疝、感觉麻木等并发症。
在浅筋膜下解剖的股外侧皮动脉穿支薄皮瓣是修复手足瘢痕挛缩畸形的有效方法，外形美观、功能恢复好、供区并发症少。
