Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
J Orthop Sci. 2024 Nov;29(6):1395-1400. doi: 10.1016/j.jos.2023.11.009. Epub 2023 Nov 25.
Selecting the optimal flap for managing digit skin defects is challenging, particularly for inexperienced surgeons, given the numerous reconstructive options and insufficient evidence supporting one flap type's superiority over another. This retrospective study introduces four efficacious hand flaps to address volar skin defects and transverse and oblique cuts, examines the optimal flap advancement distance, and discusses effective management.
Patients with digit skin defects who underwent flap surgery between 2009 and 2022 were included. Fifty-four patients treated with oblique triangular, volar VY advancement (unilateral and bilateral pedicled volar VY advancement flaps for fingers and thumbs, respectively), reverse homodigital island, and radial artery superficial palmar branch flaps were included. We evaluated the flap advancement distance, flap length, range of motion, complications, and Semmes-Weinstein monofilament test and Disabilities of the Arm, Shoulder, and Hand questionnaire results.
The median flap advancement distances for triangular oblique (19 patients), unilateral (11 patients), and bilateral pedicled (5 patients) volar VY advancement flaps were 1.3, 1.8, and 2.0 cm, respectively. The flap lengths for the reverse digital island (8 patients) and radial artery superficial palmar branch (11 patients) flaps were 2.4 and 5.0 cm, respectively. Five, three, and one cases of proximal interphalangeal flexion contractures of ≥ -20° were observed in the VY advancement, reverse digital island, and radial artery superficial palmar branch flaps, respectively. One unilateral VY advancement flap case caused severe numbness and neuroma. All complication cases featured >15 and > 20 mm defect lengths on the fingers and thumb, respectively.
To minimize sensory disruption and contractures, we recommend oblique triangular and unilateral pedicle volar VY advancement flaps for finger skin defects up to 12 mm and defects sized 12-15 mm, respectively. Advancement flaps are unsuitable for >15 and > 20-25 mm defects on the fingers and thumb, respectively.
选择最佳皮瓣来修复手指皮肤缺损具有挑战性，尤其是对于经验不足的外科医生来说，因为有许多重建选择，而且没有足够的证据支持一种皮瓣类型优于另一种。本回顾性研究介绍了四种有效的手部皮瓣，用于治疗掌侧皮肤缺损和横形及斜形切口，探讨了最佳皮瓣推进距离，并讨论了有效的处理方法。
纳入 2009 年至 2022 年间接受皮瓣手术的手指皮肤缺损患者。纳入 54 例分别接受斜三角皮瓣、掌侧 VY 推进（单侧和双侧带蒂掌侧 VY 推进皮瓣用于手指和拇指）、逆行指动脉岛状皮瓣和桡动脉掌浅支皮瓣的患者。我们评估了皮瓣推进距离、皮瓣长度、活动度、并发症以及 Semmes-Weinstein 单丝试验和上肢残疾问卷结果。
斜三角皮瓣（19 例）、单侧带蒂掌侧 VY 推进皮瓣（11 例）和双侧带蒂掌侧 VY 推进皮瓣（5 例）的皮瓣推进距离中位数分别为 1.3、1.8 和 2.0cm。逆行指动脉岛状皮瓣（8 例）和桡动脉掌浅支皮瓣（11 例）的皮瓣长度中位数分别为 2.4 和 5.0cm。VY 推进皮瓣、逆行指动脉岛状皮瓣和桡动脉掌浅支皮瓣中，近端指间关节屈曲挛缩≥-20°的病例分别为 5、3 和 1 例。单侧 VY 推进皮瓣 1 例发生严重麻木和神经瘤。所有并发症病例的手指和拇指缺损长度分别>15mm 和>20mm。
为了最大限度减少感觉障碍和挛缩，我们建议斜三角皮瓣和单侧带蒂掌侧 VY 推进皮瓣用于手指皮肤缺损<12mm 和缺损<12-15mm，对于手指和拇指的>15mm 和>20-25mm 的缺损，推进皮瓣不适用。
