Nomaguchi Matoku, Niimi Yosuke, Hasegawa Yuki, Matsumine Hajime, Sakurai Hiroyuki
From the Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2024 Sep 16;12(9):e6170. doi: 10.1097/GOX.0000000000006170. eCollection 2024 Sep.
We present a case in which reconstruction of the dorsum of the hand and finger web space was carried out concurrently with the insertion of a superficial inferior epigastric artery flap into the interdigital spaces. This approach was taken to prevent the potential development of subsequent web space contracture. The patient, a 57-year-old woman, presented with a necrotizing soft tissue infection on the dorsum of her left hand, resulting in a full-thickness skin defect extending from the metacarpophalangeal joint to the wrist, with exposure of the extensor tendons. The reconstructive surgery involved raising a superficial inferior epigastric artery flap and transplanting it onto the tissue defect, to cover not only the dorsal defect but also the interdigital spaces after releasing web space contracture. Consequently, the surgery successfully released scar contractures on the dorsum of the hand and provided adequate interdigital space formation without requiring additional procedures, except defatting. At the 7-month postoperative follow-up, the patient had a good outcome with shoulder and hand (Quick Disabilities of Arm, Shoulder and Hand) score of 28.9 points. Interdigital scar contractures often lead to decreased fine motor skills and functional impairment, affect aesthetics, and require a prolonged period for social reintegration. This surgical technique involves simultaneous one-stage closure of the dorsal defect with a flap and interdigital reconstruction to prevent future scar contractures and functional impairments, and is a valuable approach for shortening the treatment duration.
我们报告了一例病例，该病例在将腹壁下浅动脉皮瓣插入指蹼间隙的同时，对手背和指蹼间隙进行了重建。采取这种方法是为了防止随后指蹼间隙挛缩的潜在发展。患者为一名57岁女性，左手背出现坏死性软组织感染，导致全层皮肤缺损，从掌指关节延伸至腕部，伸肌腱外露。重建手术包括掀起腹壁下浅动脉皮瓣并将其移植到组织缺损处，不仅覆盖背部缺损，还在松解指蹼间隙挛缩后覆盖指蹼间隙。因此，该手术成功松解了手背的瘢痕挛缩，并且除了去脂外无需额外手术即可提供足够的指蹼间隙形成。术后7个月随访时，患者预后良好，肩手（手臂、肩部和手部快速残疾）评分为28.9分。指蹼瘢痕挛缩常导致精细运动技能下降和功能障碍，影响美观，并需要较长时间才能重新融入社会。这种手术技术涉及用皮瓣同时一期闭合背部缺损和指蹼重建，以防止未来的瘢痕挛缩和功能障碍，是缩短治疗时间的一种有价值的方法。
