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目的探讨采用趾背五边形皮瓣重建趾蹼治疗先天性并趾的临床疗效。方法回顾分析2009年1月-2014年6月,采用趾背五边形皮瓣重建趾蹼并获随访的先天性并趾患儿10例。男6例,女4例;年龄8个月~9岁,平均42个月;左足5例,右足4例;双足1例;共重建13处趾蹼。7例合并多趾畸形,1例合并短趾畸形。术后根据足趾功能及趾蹼外观、深度、坡度以及主观满意度评价手术效果。结果术后13个皮瓣均完全成活,切口Ⅰ期愈合。患儿均获随访,随访时间6~50个月,平均26个月。重建后趾蹼皮肤颜色、质地均与健侧趾蹼相似。其中9例单足患儿9处分趾后两足趾外展度达(42.879±3.703)°,与健侧(45.922±2.657)°比较,差异无统计学意义(t=—2.004,P=0.062);重建趾蹼深度为(1.881±0.266)cm,与健侧(1.631±0.202)cm比较,差异有统计学意义(t=2.248,P=0.039);重建趾蹼坡度为(42.733±3.421)°,与健侧(41.189±5.593)°比较,差异无统计学意义(t=0.707,P=0.490)。1例双足4处趾蹼重建者,左、右足重建后的趾蹼外观与正常趾蹼相似。结论采用趾背五边形皮瓣重建趾蹼治疗先天性并趾,术中无需植皮,手术操作相对简便,手术时间短,术后皮瓣成活率高;重建的趾蹼外观及足趾功能与正常足趾相似。
Objective To investigate the clinical effect of reconstruction of toe web with toe pentagon flap in the treatment of congenital toe. Methods From January 2009 to June 2014, 10 cases of congenital toe children with toe web reconstruction with toe web flap were retrospectively analyzed. 6 males and 4 females; aged 8 months to 9 years, an average of 42 months; left foot in 5 cases, right foot in 4 cases; bipedal in 1 case; a total of 13 toe webs. Seven cases had multiple toe deformities and one case had short toe deformities. According to the toe function and toe web appearance, depth, slope and subjective satisfaction after surgery, the surgical effect was evaluated. Results All 13 flaps survived completely and the incision healed in the first stage. Children were followed up for 6 to 50 months, an average of 26 months. After the reconstruction toe web color, texture and healthy side webbed similar. Among them, 9 out of 9 children with one-foot had two-toe post-apodysis with (42.879 ± 3.703) degrees of abduction and no significant difference with healthy (45.922 ± 2.657) ° (t = -2.004, P = 0.062 (1.881 ± 0.266) cm, the difference was statistically significant (t = 2.248, P = 0.039) compared with that of contralateral (1.631 ± 0.202) cm; the reef slope length was (42.733 ± 3.421) ° compared with the contralateral (41.189 ± 5.593) °, the difference was not statistically significant (t = 0.707, P = 0.490). One case of bipedal toe webbed reconstruction of four feet, left and right foot reconstruction of toe webbed look similar to the normal webbed toe. Conclusions The toe flap is used to reconstruct the toe web for the treatment of congenital toe. No skin grafting is required in the operation. The operation is relatively simple, the operation time is short, and the survival rate of the postoperative flap is high. The appearance of the toe web and the function of the toe Normal toe is similar.