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  • Title: [Repair of cicatricial contracture deformity of palm with modified free medial plantar flap with preserved abductor hallucis].
    Author: Zhang Z, Tang X, Wei Z, Jin W, Sun G, Deng C, Li H, Li S.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2018 Jul 15; 32(7):951-954. PubMed ID: 30129322.
    Abstract:
    OBJECTIVE: To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm. METHODS: Between January 2012 and July 2017, a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old (range, 15-40 years). The duration of cicatricial contracture was 4-23 years (mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site. RESULTS: All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months (mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months (mean, 9 months). At last follow-up, the flap recovered to level S 4 in 5 cases, level S 3 in 3 cases, and level S 3 in 2 cases. The two-point discrimination was 6.0-10.0 mm (mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored. CONCLUSION: The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot. 目的: 探讨保留ﾙ展肌的改良足底内侧游离皮瓣修复手掌部瘢痕挛缩畸形的疗效。. 方法: 2012 年 1 月—2017 年 7 月，采用保留ﾙ展肌的改良足底内侧游离皮瓣修复手掌部瘢痕挛缩畸形 9 例。其中男 7 例，女 2 例；年龄 15～40 岁，中位年龄 23 岁。瘢痕挛缩持续时间 4～23 年，平均 9 年。合并手关节僵硬 3 例，伴肌腱外露 2 例，肌腱合并神经外露 2 例。术中皮瓣切取范围为 4.5 cm×4.0 cm～8.0 cm×6.0 cm。皮瓣血管蒂长 7～8 cm，平均 7.5 cm。供区取髂腹股沟全厚皮片植皮修复。. 结果: 术后皮瓣及植皮均顺利成活，创面均Ⅰ期愈合。9 例患者均获随访，随访时间 5～22 个月，平均 10 个月。皮瓣外观平整，质地柔软，与周围正常皮肤相似。皮肤感觉恢复时间 5～12 个月，平均 9 个月。末次随访时，皮瓣感觉恢复为 S 4 级 5 例，S 3级 2 例，S 3 级 2 例；两点辨别觉 6.0～10.0 mm，平均 8.5 mm。根据中华医学会手外科学会上肢部分功能评定试用标准评价，手功能获优 5 例，良 2 例，可 2 例。供足ﾙ趾外展及屈曲活动均未受影响，植皮区稍有色素沉着。. 结论: 改良足底内侧游离皮瓣修复手掌部瘢痕挛缩畸形，不破坏ﾙ展肌，供区损伤小，提高了植皮成活率，供足功能不受影响。.
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