Transplantation of free great toe fibular flap for repairing traumatic soft tissue defects of hands in children

Q4 Medicine

中华小儿外科杂志 Pub Date : 2020-03-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2020.03.015

Yiyang Liu, Li-feng Shen, B. Lin, Kai Huang, Qiong Zhang, Chun Zhang, Q. Guo

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引用次数: 0

Abstract

Objective To explore the efficacy and application value of free great toe fibular flap transplantation for traumatic soft tissue defect of hands in children. Methods From July 2013 to April 2018, 11 children with hand soft tissue defects due to mechanical trauma were treated with free fibular flap. There were 10 boys and 1 girl with an average age of 11.5(5-17) years. The area of transplanted skin flaps was at 3.0 cm×1.5 cm the smallest and at 5.5 cm×2.5 cm the largest. The first dorsal metatarsal arteries (or dorsalis pedis) were anastomosed with radial arteries. Full-thickness inguinal skin was employed for free skin grafting at donor site of flaps. Results The average operative duration was 3.5 hours. One artery and two veins were anastomosed. Postoperative vascular crisis occurred in 1 case. Skin flaps survived after timely surgical exploration. And all flaps survived completely in 11 cases. Necrosis of skin graft occurred in 3 cases and there was subcrustal healing after dressing change. After an average follow-up period of 10 months, skin flaps were satisfactory in appearance, normal in color, excellent elasticity and texture and basically consistent with the surrounding tissues of recipient area. According to Michigan Hand Outcome Questionnaire, the outcomes were " very satisfied" with appearance (n=11), " very satisfied" with the function evaluation of injured fingers (n=7), " satisfied" (n=2), " unsatisfactory" (n=1) and " very unsatisfactory" (n=1). There was no obvious disturbance of toe motor function at donor site of flap. Conclusions On the basis of mastering microvascular anastomosis technique and paying attention to comprehensive managements of perioperative period of children, the transplantation of free great toe fibular flap for repairing soft tissue defect in hands has achieved satisfactory outcomes. The recipient area is aesthetic with concealed donor area and excellent functions of fingers and toes. It is worthy of wider clinical applications. Key words: Surgical flap; Microsurgery; Transplantation; Child; Soft tissue injuries; Hand injuries

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游离踇趾腓骨瓣移植修复儿童外伤性手部软组织缺损

目的探讨游离踇趾腓骨皮瓣移植治疗儿童外伤性手部软组织缺损的疗效及应用价值。方法2013年7月~ 2018年4月，对11例因机械损伤导致手部软组织缺损的患儿采用游离腓骨瓣修复。男10例，女1例，平均年龄11.5岁(5-17岁)。移植皮瓣面积最小3.0 cm×1.5 cm，最大5.5 cm×2.5 cm。第一跖背动脉(或足背动脉)与桡动脉吻合。采用全层腹股沟皮肤在皮瓣供区游离植皮。结果平均手术时间3.5 h。一条动脉和两条静脉吻合。术后血管危象1例。皮瓣在及时手术探查后存活。11例皮瓣全部存活。3例移植皮出现坏死，换药后皮下愈合。平均随访10个月，皮瓣外观满意，颜色正常，弹性和质地优良，与受区周围组织基本一致。根据《Michigan Hand Outcome Questionnaire》，对损伤手指的外观评价为“非常满意”(n=11)，对损伤手指的功能评价为“非常满意”(n=7)，“满意”(n=2)，“不满意”(n=1)，“非常不满意”(n=1)。皮瓣供区足部运动功能未见明显改变。结论在掌握微血管吻合技术的基础上，注意儿童围手术期的综合管理，游离踇趾腓骨瓣移植修复手部软组织缺损取得了满意的效果。受区美观，供区隐蔽，手指、脚趾功能良好。值得临床推广应用。关键词:外科皮瓣;显微外科;移植;孩子;软组织损伤;手受伤

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.