Department of Orthopaedic Surgery, Ichinomiya-Nishi Hospital, Ichinomiya, Japan.
Department of Orthopaedic Surgery, Nara Medical University, 840 Shijyo-Cho, Kashihara, Nara, 634-8522, Japan.
Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1627-1634. doi: 10.1007/s00590-024-03854-5. Epub 2024 Feb 17.
This study aimed to describe the reposition flap for reconstructing fingertip amputation when replantation is not possible.
This study retrospectively reviewed the records of patients with reposition flap transfers and investigated postoperative clinical outcomes and patient satisfaction. Sixteen patients with fingertip amputations treated with a reposition flap from 2016 to 2020. The mean age at injury was 46 years (range, 26-70 years). Ten cases were treated with oblique triangular advancement flaps, 3 with retrograde-flow digital artery flaps, and 3 with thumb palmar advancement flaps. Postoperative outcomes, including wound healing period and the IP/PIP extension angle, and the presence of grafted bone absorption and patient satisfaction were evaluated as of 3 years after surgery.
The average reduction in passive extension angle of the IP/PIP joint was 19°. The average time for complete wound healing was 28 days (range, 18-41 days). The reduction in passive extension angle of the IP/PIP joint was significantly correlated with the wound healing period (r = 0.66, p = 0.01). The absorption of the grafted bone was observed in 3 cases. In these cases, the distal tip of the flap became thin due to flap retraction and an insufficient flap volume. All patients were highly or fairly satisfied with the results of surgery.
Our findings show that IP/PIP flexion contracture can occur due to delayed wound healing after reposition flap transfer, but the patient satisfaction level was generally high. Therefore, reconstruction using a reposition flap gives acceptable clinical outcomes and high patient satisfaction as a result of medium to long-term.
本研究旨在描述当再植术不可行时，用于重建指尖离断的复位皮瓣。
本研究回顾性分析了接受复位皮瓣转移治疗的患者的记录，并调查了术后临床结果和患者满意度。2016 年至 2020 年期间，有 16 例指尖离断患者接受了复位皮瓣治疗。损伤时的平均年龄为 46 岁（范围，26-70 岁）。10 例采用斜角推进皮瓣，3 例采用逆行指动脉皮瓣，3 例采用拇指掌侧推进皮瓣。术后评估包括伤口愈合期和指间关节（IP）/近节指间关节（PIP）的伸展角度、移植骨吸收的情况以及患者满意度。
IP/PIP 关节被动伸展角度的平均减少量为 19°。完全愈合的平均时间为 28 天（范围，18-41 天）。IP/PIP 关节被动伸展角度的减少与伤口愈合时间显著相关（r=0.66，p=0.01）。3 例观察到移植骨吸收。在这些病例中，由于皮瓣回缩和皮瓣体积不足，皮瓣的远端尖端变薄。所有患者对手术结果高度满意或较为满意。
我们的研究结果表明，由于复位皮瓣转移后伤口愈合延迟，可能会导致 IP/PIP 关节屈曲挛缩，但患者的满意度水平通常较高。因此，使用复位皮瓣进行重建可获得可接受的临床结果和较高的患者满意度，这是中、长期的结果。
