Objective: To explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication.
Methods: Twelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of abdominal circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring.
Results: All the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry was improved in all cases. The ratio of abdominal circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases.
Conclusion: The anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
目的: 探讨指动脉顺行筋膜瓣对 Wassel Ⅳ-D 型复拇畸形进行指体重建、美学修复的效果。.
方法: 2014 年 6 月—2017 年 3 月，共收治 12 例 Wassel Ⅳ-D 型复拇畸形患儿。其中男 7 例，女 5 例；年龄 9～32 个月，平均 13.3 个月。左侧 8 例，右侧 4 例。主拇甲床横径为健侧的 70%～85%，平均 75.3%；饱满度为健侧的 50%～75%，平均 62.4%。采用携带一侧指固有动脉的顺行筋膜瓣填充保留指桡侧甲侧襞并增加指体周径。末次随访时于甲根部测量畸形指矫形后指腹周径相对于健侧指腹周径的比例；采用日本手外科学会评分（JSSH）对所有重建拇指的外观及功能进行评价。.
结果: 手术均顺利完成，术后无感染、皮肤坏死等早期并发症发生。所有患儿均获随访，随访时间 7～27 个月，平均 14.3 个月。末次随访时指体无“Z”样畸形复发，手术创面无明显瘢痕挛缩。所有患儿重建拇指两侧甲侧襞基本对称，指体周径达健侧的 93%～96%，平均 94.7%。JSSH 评分为 15～20 分，平均 17.9 分；获优 8 例，良 2 例，中 2 例。.
结论: 采用指动脉顺行筋膜瓣对 Wassel Ⅳ-D 型复拇畸形进行指体重建，指体细小及甲侧襞不对称均获得明显改善，能获得较好的美学修复。.
Keywords: Anterograde fascial flap of digital artery; microsurgery; thumb duplication.