Chen Hua, Wu Kang, Wang Hongrui, Hu Yong, Wang Yang
Department of Hand and Foot Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China.
Front Pediatr. 2024 Nov 18;12:1433249. doi: 10.3389/fped.2024.1433249. eCollection 2024.
Radial deviation of the interphalangeal (IP) joint is a common complication of treating Wassel type IV-D preaxial polydactyly. Long-term radial deviation can place excessive tension on the radial skin and cause overabundance of the ulnar skin. To overcome this problem, we aimed to utilize a fascial flap for ulnar reconstruction of a defect in the radial skin.
We used a fascial flap for ulnar reconstruction of a defect in the radial skin, eight patients (average: 12 years, range: 5-33 years) who underwent reconstructive surgery at our department for radial deviation of the interphalangeal (IP) joint after the initial operation were included between August 2017 and August 2021. An incision was made on the radial side of the thumb. An olive-shaped flap was designed on the ulnar eminence of the IP joint. The skin and fascia in the other three quadrants were incised. While the flap was protected, children with epiphyseal plates underwent wedge osteotomy at the maximum ulnar deviation of the proximal phalanx, and adults underwent direct fusion of the distal IP joint. Absorbable sutures were used to suture the flap. The Tada functional and visual analog scale (VAS) scores were recorded before and after the operation.
All flaps survived without infection or necrosis. The preoperative and postoperative Tada scores were 1 and 5, respectively, and the preoperative and postoperative VAS scores were 3 and 9, respectively. The postoperative scores showed a statistically significant degree of improvement.
An ulnar fascial flap is an effective and feasible option for repair of radial deviation following surgery for preaxial polydactyly.
指间关节桡侧偏斜是治疗 Wassel IV-D 型拇指多指畸形的常见并发症。长期的桡侧偏斜会使桡侧皮肤承受过度张力，并导致尺侧皮肤过多。为克服这一问题，我们旨在利用筋膜瓣对桡侧皮肤缺损进行尺侧重建。
我们采用筋膜瓣对桡侧皮肤缺损进行尺侧重建，纳入了 2017 年 8 月至 2021 年 8 月期间在我科接受初次手术后因指间关节桡侧偏斜而进行重建手术的 8 例患者（平均年龄 12 岁，范围 5 - 33 岁）。在拇指桡侧做切口。在指间关节尺侧隆起处设计一个橄榄形皮瓣。切开其他三个象限的皮肤和筋膜。在保护皮瓣的同时，骨骺板未闭合的儿童在近端指骨最大尺侧偏斜处进行楔形截骨，成人则进行远侧指间关节直接融合。使用可吸收缝线缝合皮瓣。记录手术前后的多田功能和视觉模拟评分（VAS）。
所有皮瓣均存活，无感染或坏死。术前和术后的多田评分分别为 1 分和 5 分，术前和术后的 VAS 评分分别为 3 分和 9 分。术后评分显示有统计学意义的显著改善。
尺侧筋膜瓣是修复拇指多指畸形手术后桡侧偏斜的一种有效且可行的选择。
