Application of dual intersecting trapezoid flap in the treatment of scar flexion contractures of fingers / 中华骨科杂志

ABSTRACT

Objective To explore the procedure method and treatment outcome for the dual intersecting trapezoid flaps for repairing flexion contractures of fingers.Methods From February 2013 to April 2015,data of 26 fingers in 11 patients with flexion contractures who were treated with dual intersecting trapezoid flaps and followed up for more than 1 year were retrospectively analyzed.There were 7 males (16 fingers) and 4 females (10 fingers) with an average age of 38.2 years old (ranged from 28 to 60 years old).17 cases of right finger,and 9 cases of the left.There were 8 fingers of mild contracture,14 fingers of moderate contracture,and 4 fingers of severe contracture.Take the scar wrinkle tension line as the central axis,the distance was from 0.5cm to 0.Scm,and decompose the medial axis evenly,form several symmetrical trapezoid skin flaps on the radial side and ulnar side of the fingers.The direction of the double arm of the trapezoid flap is relative to the angle of the central axis from 60° to 70°,and the double skin flap is interlaced.Incisions were designed in a dual intersecting trapezoid flap over the contracture.Coverd the wound with excess skin and scar folds on the dorsal side of the lateral and interphalangeal joints,and full thickness skin graft was utilized to repair skin defect.Results All 24 flaps survived without blood circulation disorders and infections.Only 2 cases appeared flap tip necrosis,delayed healing.The mean active extension and flexion of DIP joints in mild contracture patients were-3° (ranged from-8° to 0°) and 45° (range from 30° to 60°),respectively;and PIP joints were-5° (ranged from-10° to 0°)and 90° (ranged from 70° to 110°),respectively.Contracture scars were extended by an average of 150％.The mean active extension and flexion of DIP joints in moderate contracture in patients were-5° (ranged from-9° to 0°) and 35° (ranged from 20° to 50°),respectively;and PIP joints were-5° (ranged from-10° to 0°) and 85° (ranged from 75° to 120°),respectively.Contracture scars were extended by an average of 130％.The mean active extension and flexion of DIP joints in severe contracture patients were-8° (ranged from-15° to-5°) and 17° (ranged from 10° to 25°),respectively;and PIP joints were-8° (ranged from-10° to-5°) and 78° (ranged from 70° to 90°),respectively.Contracture scars were extended by an average of 220％.According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association,mild contracturethe results were rated as excellent in 6 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 87.5％;moderate contracturethe results were rated as excellent in 12 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 92.9％;severe contracturethe results were rated as excellent in 2 cases,good in 1 case and fair in 1 case.The overall satisfactory rate was 75％.Conclusion The dual intersecting trapezoid flap plasty is easy to use,which has rich vascularity and mobility,and it is a good way to correct the cross-joint scar contracture flexion deformity with less complications.