Plantar intermetatarsal perforator flap for first web skin-graftless syndactyly release: Anatomical study and clinical application

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-02-16 DOI:10.1002/micr.31151
Francisco Soldado MD, PhD, Jose Antonio Prieto-Mere MD, Abdelmounim Cherqaoui MD, Paula Diaz Gallardo MD, Jorge Knorr MD, Pablo Corona MD
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引用次数: 0

Abstract

Introduction

Foot-syndactyly has long been managed through conventional surgical procedures, each having its own distinct advantages and drawbacks. While these methods, which do not require skin grafts, exhibit a lower incidence of long-term complications, they lead to undesirable scarring on the dorsal side of the foot and reduced patient satisfaction. In this study, we introduce an innovative technique involving an intermetatarsal plantar flap, supported by an anatomical investigation and clinical application.

Methods

Eight freshly preserved lower limbs were injected with colored latex to examine the cutaneous vessels on the plantar surface, a skin-flap was designed in an elliptical shape to address first web conjoined toes. The flap was extended from the center of each affected ray measuring ~30% of the sole's length. Using the mentioned novel approach, a flap was created and dorsally extended with a straight incision to release bilateral simple foot-syndactyly in an 8-year-old child presented with Apert's Syndrome.

Results

We identified cutaneous branches originating either from the medial plantar vessels or the lateral proper artery of the hallux. On average, the mean number of cutaneous branches found over the first intermetatarsal web spaces was 5.8 (ranging from 5 to 8) most of them originating from medial plantar vessels with a mean of 5.1 branches (range 4–6) while proper lateral great-toe digital artery provided a mean of 0.6 branches (range 0–2). Intra-operatively, in our patient, advancing the plantar flap ensured complete coverage of the commissure, obviating the necessity for skin grafts. Incisions healed uneventfully and a wide first web was obtained. Over a 15 months follow-up, no complications were observed.

Conclusions

Our findings suggest that the skin-graftless first web release of syndactyly using a plantar intermetatarsal flap is a reliable and straightforward procedure with good cosmetic results, offering a promising alternative to conventional techniques.

Level of evidence

Therapeutic IV.

用于第一蹼无植皮联合畸形松解术的跖间穿孔器皮瓣:解剖学研究与临床应用
简介长期以来,人们一直通过传统的外科手术方法来治疗足拇趾发育不良,每种方法都有其独特的优点和缺点。这些方法无需植皮,长期并发症发生率较低,但会在足背侧留下不良瘢痕,降低患者满意度。在本研究中,我们介绍了一种涉及跖间皮瓣的创新技术,并辅以解剖学研究和临床应用:方法:在八只新鲜保存的下肢上注射彩色乳胶,以检查足底表面的皮肤血管。皮瓣从每条受影响射线的中心延伸,长度约为脚底长度的 30%。我们采用上述新方法制作了一个皮瓣,并通过直切口向背侧延伸,为一名患有阿博特综合征的 8 岁儿童解除了双侧单纯趾挛缩症:结果:我们确定了源自足底内侧血管或拇指外侧正中动脉的皮支。在第一跖蹼间隙发现的皮肤分支平均为 5.8 个(5 至 8 个不等),其中大部分源自内侧足底血管,平均为 5.1 个分支(4 至 6 个不等),而大趾外侧数字动脉提供的分支平均为 0.6 个(0 至 2 个不等)。术中,在我们的患者中,推进足底皮瓣可确保完全覆盖关节窝,从而避免了植皮的必要性。切口愈合顺利,第一蹼较宽。随访 15 个月,未发现并发症:我们的研究结果表明,使用跖间皮瓣进行无植皮第一蹼松解术治疗腓骨联合畸形是一种可靠而简单的手术,具有良好的美容效果,是传统技术的一种很有前途的替代方法:证据级别:IV 级治疗。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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