The Use of Mitten-Shaped Thin Abdominal Flap for the Coverage of Extensive Compound Dorsal Hand Defect in a Pediatric Patient

使用手套型腹部皮瓣重建幼兒手部大面積皮膚缺損

朱純慧(Chun-Hui Chu) ； 蔡文平(Wen-Ping Tsai) ； 李經維(Jing-Wei Lee)

《中華民國整形外科醫學會雜誌》 18卷4期 (2009/12) Pp. 353-361

https://doi.org/10.7096/JPSA.200912.0353

摘要

背景：
泡沫紅茶店在台灣的盛行，使得自動封口杯機器大量生產，以提高飲料製成的方便性與效率性。然而，隨之而來的即是封口杯機器造成的傷害，例如割傷、截斷指、或者是接觸性灼傷等等。這些傷害的機會常常發生在好奇的幼童手上，造成極為嚴重的手部創傷，為考量日後功能及外觀，以及某些重建方式對於幼兒的合適度等方面，幼兒手部的創傷重建成為一項困難的挑戰。
目標：
對於幼兒嚴重的手部創傷，以腹部皮瓣手術來重建是一項安全而且有效的方式。
材料與方式：
一個18個月大的小男孩，在嬉戲時不小心被自動封口杯機器杯口的高溫高壓接觸性三度灼傷至左手背，第三、四、和五指的伸指肌腱部分喪失，以及指骨頭與指間關節的外露等問題。經過清創手術及傷口照顧之後，我們以左大腿股肌膜張肌作為肌腱移植物，重建伸指肌腱及部份喪失的關節韌帶後，再設計遠端腹部皮瓣覆蓋手部大規模的皮膚缺損以及重要結構外露。同時也考量幼兒對於腹部皮瓣的適應性與固定性，我們設計一個全軀幹人形石膏，防止幼兒逃脫手與腹部的連結，並且因顧及整體皮瓣的穩定性，經由內支架的設計避免手部或軀體的旋轉與外展等活動。
結果：
經由14天的皮瓣照顧，將手部與腹部皮瓣分割，腹部皮膚缺損則是以補皮手術處理。再經由兩次的併指分離手術，此位小男孩成功的獲得功能上及外觀上良好的左手。
結論：
經由此案例，對於普遍性很高的腹部皮瓣手術運用於幼兒手部創傷，我們提供了一個成功的經驗。

並列摘要

Background:
Severe hand trauma in small children has special social, psychological, aesthetic and functional implications that mandate comprehensive treatment strategies. Because of the miniaturized size of the limbs and the incautiousness of the little kids, the injury tends to have a substantial severity and extent. Moreover, the physicians will encounter considerable difficulties while attempting the reconstructive task and implementing the post operative care, also owing to the tiny structural components and the uncooperativeness of the toddlers.
Aim and Objectives:
To reconstruct the severe hand injury in Pediatrics by using the abdominal flap was an efficient and safety method.
Materials and Methods:
This report describes an 18-month-old boy who sustained 3rd degree contact burn over his left dorsal hand with multiple extensor tendon loss, joint and bone exposure, and large skin defect due to autonomic cup-sealing machine injury. He received abdominal flap transfer for wound coverage in conjunction with immediate tendon and lateral bands reconstruction using tensor fascia lata graft. A whole body spica was used to prevent premature detachment of the limb from the abdomen donor site during the two weeks period of immobilization. A special ”mitten like” flap design was utilized, which served to ensure a stable limb anchorage and enable maximal contact surface between the two parties with minimal enrollment of unnecessary donor tissue. An optimal thinning of the flap thickness can be achieved without safety concern. The flap was divided two weeks later and two more surgeries were conducted subsequently to separate the syndactylous fingers. A reasonable final functional result was obtained without significant donor site morbidity. The rational and technical details as well as the special measure of postoperative immobilization were described in this article.
Results:
No flap partial necrosis or total necrosis was found in each surgery including of reconstructive and division operation. No donor site co-morbidity was noted. Three hundred eighteen days after abdominal flap surgery, or 155 days following complete flap division, no significant complication related either to the donor or recipient sites and an acceptable functional performance is achieved.
Conclusion:
The method of traditional abdominal flap transfer, is easy to execute, highly accountable, vastly flexible and versatile in flap design, and would be particularly valuable for young aged individual.

並列關鍵字

Pediatric hand injury ； abdominal flap ； whole body spica