目的 探讨应用改良Quaba皮瓣修复手、足部远端软组织缺损的临床效果。 方法 2013年8月至2022年3月,新疆医科大学第一附属医院骨科中心显微修复外科应用改良Quaba皮瓣修复手、足部远端软组织缺损36例,男24例，女12例，年龄18~58岁，平均35.6岁。手部28例，足部8例；外伤性软组织缺损26例，手部慢性感染5例，手部肿瘤切除术后5例。创面缺损面积1.5 cm×0.5 cm~5.0 cm×3.0 cm，皮瓣大小为5.0 cm×1.5 cm~10.0 cm×6.5 cm。优化方法:①延长皮瓣的桨叶或旋转点向远端移动；②确定进入蒂部的穿支血管,发出穿支位置为旋转点,保证最大的血流灌注；③增加蒂部活动度，减少皮瓣的旋转角度；④均保留蒂部浅静脉；⑤合理地保留蒂部的筋膜组织；⑥蒂部"皮尾"设计。术后采用门诊预约复查、电话和微信的方式定期随访，评估皮瓣的颜色、质地、创面愈合情况、供区并发症及手功能。 结果 术后36例皮瓣全部成活，供区直接闭合27例，皮片移植9例。随访3~36个月，平均24个月，所有皮瓣色泽、质地良好，感觉迟钝，创面愈合。28例手功能按照中华医学会手外科学会上肢部分功能评定试用标准进行评定：优23例，良3例，可2例，优良率为92.9%。所有患者掌指关节活动满意，屈曲65°~90°，平均80°；背伸0°~20°，平均8°，均无明显关节疼痛。8例足部按照美国矫形足踝外科协会（AOFAS）趾跖趾-趾间功能评分：优6例，良2例。 结论 改良Quaba皮瓣切取简便、血流循环稳定可靠，优化方法可延长皮瓣的桨叶、降低旋转轴点，是修复手、足部远端软组织缺损非常有效的一种方法。 Objective To explore the clinical effect of the modified Quaba flap on reconstruction of the soft tissue defects in distal hand and foot. Methods From August 2013 to March 2022, 36 cases of soft tissue defect in distal hand and foot were reconstructed by the modified Quaba flap in the Department of Microrepair and Reconstruction of Orthopaedic Centre, the First Affiliated Hospital of Xinjiang Medical University. There were 24 males and 12 females, aged 18 to 58 years old with an average age of 35.6 years old. The sizes of defect were 1.5 cm × 0.5 cm - 5.0 cm × 3.0 cm, including 28 in hand and 8 in foot. Of the defects, 26 were traumatic soft tissue defects, 5 were chronic hand infection and 5 were after resection of hand tumour. The sizes of flap employed were 5.0 cm × 1.5 cm - 10.0 cm × 6.5 cm. Method of optimization included: (1) Extended the paddle of propeller flap or made the rotation point being further (2) Determined the perforator vessel that entered the pedicle, and made the perforating point as the location of rotation hence to maximise a blood flow (3) Improved the pedicle mobility and reduced the angle of rotation of the flap (4) The superficial vein in the pedicle was retained in the modified Quaba flap (5) Properly retained the fascia tissue of the pedicle (6) "Skinned-tail" design for the pedicle. All patients entered scheduled follow-up reviews at outpatient clinic and by telephone or WeChat interviews. Colour, texture, wound healing, complications at donor site and hand function were evaluated. Results All flaps survived. The donor sites were directly closed in 27 patients, and skin grafts were applied in 9 patients. All patients were entered postoperative follow-up for 3-36(mean 24) months. All flaps had good colour and texture but with poor sensation. Wounds healed at the first attention. Hand functions(28 cases) were evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Hand function appeared excellent in 23 patients, good in 3 and fair in 2, with an excellent and good rate at 92.9%. Motion of all metacarpophalangeal joints were satisfactory. Flexion of metacarpophalangeal joints ranged from 65° to 90°, with an average of 80°. Dorsal extension ranged from 0° to 20° (mean 8°), without obvious joint pain. Foot functions(8 cases) were evaluated according to hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society (AOFAS), 6 patients were in excellent and 2 in good. Conclusion Modified Quaba flap is easy to harvest and with stable and reliable blood circulation. The optimised methods can extend the length of the paddle of the flap and shorten the rotation point. They are very effective methods in reconstruction of the soft tissue defect in distal hand and foot.
Abstract
Objective To explore the clinical effect of the modified Quaba flap on reconstruction of the soft tissue defects in distal hand and foot. Methods From August 2013 to March 2022, 36 cases of soft tissue defect in distal hand and foot were reconstructed by the modified Quaba flap in the Department of Microrepair and Reconstruction of Orthopaedic Centre, the First Affiliated Hospital of Xinjiang Medical University. There were 24 males and 12 females, aged 18 to 58 years old with an average age of 35.6 years old. The sizes of defect were 1.5 cm × 0.5 cm - 5.0 cm × 3.0 cm, including 28 in hand and 8 in foot. Of the defects, 26 were traumatic soft tissue defects, 5 were chronic hand infection and 5 were after resection of hand tumour. The sizes of flap employed were 5.0 cm × 1.5 cm - 10.0 cm × 6.5 cm. Method of optimization included: (1) Extended the paddle of propeller flap or made the rotation point being further (2) Determined the perforator vessel that entered the pedicle, and made the perforating point as the location of rotation hence to maximise a blood flow (3) Improved the pedicle mobility and reduced the angle of rotation of the flap (4) The superficial vein in the pedicle was retained in the modified Quaba flap (5) Properly retained the fascia tissue of the pedicle (6) "Skinned-tail" design for the pedicle. All patients entered scheduled follow-up reviews at outpatient clinic and by telephone or WeChat interviews. Colour, texture, wound healing, complications at donor site and hand function were evaluated. Results All flaps survived. The donor sites were directly closed in 27 patients, and skin grafts were applied in 9 patients. All patients were entered postoperative follow-up for 3-36(mean 24) months. All flaps had good colour and texture but with poor sensation. Wounds healed at the first attention. Hand functions(28 cases) were evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Hand function appeared excellent in 23 patients, good in 3 and fair in 2, with an excellent and good rate at 92.9%. Motion of all metacarpophalangeal joints were satisfactory. Flexion of metacarpophalangeal joints ranged from 65° to 90°, with an average of 80°. Dorsal extension ranged from 0° to 20° (mean 8°), without obvious joint pain. Foot functions(8 cases) were evaluated according to hallux metatarsophalangeal-interphalangeal scale of the American Orthopaedic Foot and Ankle Society (AOFAS), 6 patients were in excellent and 2 in good. Conclusion Modified Quaba flap is easy to harvest and with stable and reliable blood circulation. The optimised methods can extend the length of the paddle of the flap and shorten the rotation point. They are very effective methods in reconstruction of the soft tissue defect in distal hand and foot.
万方数据