Modified Souquet Flap for Releasing Flexion Contracture of the Proximal Interphalangeal Joint

運用重新設計的Souquet皮瓣來鬆弛近指間關節的屈曲攣縮

林有德(Yu-Te Lin) ； Charles Yuen Yung Loh

《臺灣整形外科醫學會雜誌》 26卷3期 (2017/09) Pp. 255-261

摘要

Background: Flexion contracture of the proximal interphalangeal joint (PIPJ) causes disability of the hand function. When the PIPJ is not arthritic, correction of flexion contracture can be accomplished by releasing the affected soft tissues and tendons. Pedicled and free flaps have been used to cover the vital structures after releasing the flexion contracture of the PIPJ. Herein, we described a redesigned Souquet flap to release soft tissue contracture of the PIPJ. Materials and Methods: Modified Souquet flaps were performed in 12 patients. The age of the patients was from 1.6 to 69.5 years. All the affected fingers failed to improve with conservative measurements. The extension lag of the PIPJs was 59.2° (35° - 95°). The arc of motion (AOM) of the PIPJs was 23.3° (0° - 55°). Preoperatively, the distance of volar skin from the palmar digital crease to the fingertip was compared to that of the contralateral digit. Shorter cutaneous tissues of the affected digit have been assessed with or without contracture of the other deep structures. Incisions of modified Souquet flaps were designed to facilitate approach and release the contracted PIPJ. Results: The modified Souquet flaps were advanced for 7.5 - 14mm (10.5mm in average). No skin flap experienced arterial or venous insufficiency. The patients were followed for 6.2 - 11.8 months (7.9 months in average). All the digits were improved in active ROM. The extension lag of the PIPJs at the last outpatient clinics was 12.5° (0° - 35°). The AOM of the PIPJs was 74.2° (40° - 100°). There was a significant difference between the pre-operative and post-operative AOMs of the digits (p=0.0001). Conclusion: This redesigned Souquet flap provides a valuable option for flexion contracture release. The technique offers contracture lengthening of approximately 10-15 mm. It is designed as an advancement flap to include both digital neurovascular bundles, and to allow primary closure of the subsequent defect, obviating the need for secondary skin grafting. The advantage of this design lies in its simplicity, resulting in less potential morbidity.

關鍵字

souquet flap ； hueston flap ； moberg flap ； flexion contractures ； proximal interphalangeal joint

並列摘要

背景：手指近指間關節屈區攣縮往往造成病人手功能的障礙。當指間關節並沒有關節炎的現象時，藉由把緊縮的軟組織及肌腱鬆弛之後，屈曲攣縮就可以被改善。過去已經有不少的根蒂式或游離式的皮瓣被報導，用來覆蓋指關節鬆弛術後重要結構外露的問題。在這一篇文章中，我們敘述一個經過重新設計的Souquet皮瓣，用於鬆弛近指間關節的軟組織攣縮。材料及方法：總共有12個病人接受重新設計的Souquet皮瓣手術治療。病人的年紀從1.6到69.5歲，所有攣縮的手指都是在接受過復健治療之後仍無法改善。手術前近指間關節伸展短少59.2° (35° - 95°)，主動性的活動角度約23.3° (0° - 55°)。術前測量從掌指指紋到指尖的長度，攣縮手指的皮膚組織比起對側手指的皮膚組織要短少。於是在做手術設計時，我們就採取重新設計的Souquet皮瓣切割來探查及鬆弛攣縮的近指間關節。結果：重新設計的Souquet皮瓣被前移的程度從7.5 - 14毫米（平均10.5毫米）。所有的皮瓣都沒有經歷到動脈或靜脈的血循不良。病人追蹤及復健約在6.2 - 11.8個月（平均7.9個月），所有攣縮手指的活動度都獲得改善。在最後一次門診追蹤時的近指間關節伸展短少為12.5° (0° - 35°)，主動式的活動角度為74.2° (40° - 100°)。這些手指的術前、術後活動角度有統計上顯著的差異(p=0.0001)。結論：重新設計的Souquet皮瓣在改善近指間關節屈曲攣縮時，是一個有價值的選擇。這個皮瓣大約可以被前移10-15毫米。它的設計上在皮瓣內包含了兩側的指神經血管束，同時也提供工皮瓣區能夠直接被縫合起來，少掉了另外補皮的需求。因此讓皮瓣的血液循環更理想，也更少術後的併發症。