目的 探讨对偶交叉梯形皮瓣治疗手指瘢痕挛缩屈曲畸形的方法及疗效.方法 回顾性分析2013年2月至2015年4月采用对偶交叉梯形皮瓣治疗且获得平均1年以上随访的11例(26指)手指瘢痕挛缩屈曲畸形患者资料,其中男7例(16指),女4例(10指);年龄28～60岁,平均38.2岁;左侧17指,右侧9指.轻度挛缩8指,中度挛缩14指,重度挛缩4指.以瘢痕皱褶张力线为中轴线,间距0.5～0.8 cm将中轴线平均分解,在手指桡侧面及尺侧面形成若干相互对称的梯形皮瓣,梯形皮瓣的双臂方向相对,与中轴线成角60°～70°,将对偶皮瓣交错缝合,利用指侧方及指间关节背侧过剩的皮肤和瘢痕皱褶覆盖创面,皮肤缺损采用全厚皮片移植修复.结果 24指皮瓣均未发生血液循环障碍及感染,全部成活.2指皮瓣边缘少许坏死,延期愈合.轻度挛缩患者远指间关节主动伸直平均-3°(-8°～0°),主动屈曲平均45°(30°～60°);近指间关节主动伸直平均-5°(-10°～0°),主动屈曲平均95°(70°～110°);挛缩瘢痕平均延长150％.中度挛缩患者远指间关节主动伸直平均-5°(-9°～0°),主动屈曲平均35°(20°～50°);近指间关节主动伸直平均-5°(-10°～0°),主动屈曲平均85°(70°～120°);挛缩瘢痕平均延长130％.重度挛缩患者远指间关节主动伸直平均-8°(-15°—5°),主动屈曲平均17°(10°～25°);近指间关节主动伸直平均-8°(-10°～-5°),主动屈曲平均78°(70°～90°).挛缩瘢痕平均延长220％.达到改善瘢痕挛缩屈曲畸形的治疗效果.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定:轻度挛缩:优6例,良1例,可1例;优良率87.5％.中度挛缩:优12例,良1例,可1例;优良率92.9％.重度挛缩:优2例,良1例,可1例;优良率75％.结论 对偶交叉梯形皮瓣血供可靠,手术操作简单易行,并发症少,是矫正手指跨关节瘢痕挛缩屈曲畸形的良好办法.%Objective To explore the procedure method and treatment outcome for the dual intersecting trapezoid flaps for repairing flexion contractures of fingers.Methods From February 2013 to April 2015,data of 26 fingers in 11 patients with flexion contractures who were treated with dual intersecting trapezoid flaps and followed up for more than 1 year were retrospectively analyzed.There were 7 males (16 fingers) and 4 females (10 fingers) with an average age of 38.2 years old (ranged from 28 to 60 years old).17 cases of right finger,and 9 cases of the left.There were 8 fingers of mild contracture,14 fingers of moderate contracture,and 4 fingers of severe contracture.Take the scar wrinkle tension line as the central axis,the distance was from 0.5cm to 0.Scm,and decompose the medial axis evenly,form several symmetrical trapezoid skin flaps on the radial side and ulnar side of the fingers.The direction of the double arm of the trapezoid flap is relative to the angle of the central axis from 60° to 70°,and the double skin flap is interlaced.Incisions were designed in a dual intersecting trapezoid flap over the contracture.Coverd the wound with excess skin and scar folds on the dorsal side of the lateral and interphalangeal joints,and full thickness skin graft was utilized to repair skin defect.Results All 24 flaps survived without blood circulation disorders and infections.Only 2 cases appeared flap tip necrosis,delayed healing.The mean active extension and flexion of DIP joints in mild contracture patients were-3° (ranged from-8° to 0°) and 45° (range from 30° to 60°),respectively;and PIP joints were-5° (ranged from-10° to 0°)and 90° (ranged from 70° to 110°),respectively.Contracture scars were extended by an average of 150％.The mean active extension and flexion of DIP joints in moderate contracture in patients were-5° (ranged from-9° to 0°) and 35° (ranged from 20° to 50°),respectively;and PIP joints were-5° (ranged from-10° to 0°) and 85° (ranged from 75° to 120°),respectively.Contracture scars were extended by an average of 130％.The mean active extension and flexion of DIP joints in severe contracture patients were-8° (ranged from-15° to-5°) and 17° (ranged from 10° to 25°),respectively;and PIP joints were-8° (ranged from-10° to-5°) and 78° (ranged from 70° to 90°),respectively.Contracture scars were extended by an average of 220％.According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association,mild contracture:the results were rated as excellent in 6 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 87.5％;moderate contracture:the results were rated as excellent in 12 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 92.9％;severe contracture:the results were rated as excellent in 2 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 75％.Conclusion The dual intersecting trapezoid flap plasty is easy to use,which has rich vascularity and mobility,and it is a good way to correct the cross-joint scar contracture flexion deformity with less complications.
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