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目的探讨风筝样切口联合全厚皮片移植修复严重指蹼瘢痕挛缩畸形的疗效。方法 2008年6月-2011年9月,收治指蹼瘢痕挛缩畸形患者31例(87个指蹼)。男24例,女7例;年龄5～43岁,中位年龄22岁。致伤原因:火焰烧伤26例,热液烫伤3例,电弧烧伤1例,化学烧伤1例。损伤分度:深Ⅱ度14例,Ⅲ度17例。受伤至该次手术时间10个月～17年,中位时间2.2年。设计风筝样切口,切除相邻掌指关节间的菱形瘢痕并充分松解指蹼间瘢痕粘连,继发创面采用全厚皮片移植修复。供皮区拉拢缝合。结果术后全厚皮片均成活,供皮区切口Ⅰ期愈合。29例(82个指蹼)获随访;随访时间6～18个月,平均13个月。再造指蹼大小及深度均类似正常指蹼,无继发挛缩,各手指活动度良好。结论采用风筝样切口联合全厚皮片移植修复严重指蹼瘢痕挛缩畸形可获得较好近期疗效,远期疗效需进一步观察。
Objective To investigate the curative effect of kite-like incision combined with full-thickness skin grafts in the repair of severe contracture and deformity of the web. Methods From June 2008 to September 2011, 31 patients (87 finger webs) with webbed contracture deformities were treated. 24 males and 7 females; aged 5 to 43 years old, the median age of 22 years. Causes of injury: flame burn in 26 cases, hydrothermal burns in 3 cases, 1 case of electric arc burn, 1 case of chemical burn. Degree of injury: deep Ⅱ degree in 14 cases, Ⅲ degree in 17 cases. Injured to the operation time 10 months to 17 years, the median time of 2.2 years. Kite-like incision design, resection of rhombic scar between adjacent metacarpophalangeal joints and the full release of scar adhesion between finger webbed, secondary wounds with full thickness skin graft repair. For the skin area suture. Results After operation, the full-thickness skin flap survived, and the incision in the donor site was healed in the first stage. Twenty-nine patients (82 finger webs) were followed up for 6-18 months (average 13 months). The rebuilt finger webs are similar in size and depth to normal finger webs, with no secondary contractures and good finger movement. Conclusions Kite-like incision combined with full-thickness skin grafts for repairing severe contracture deformity of the web can provide better short-term curative effect. The long-term curative effect needs further observation.