使用“触角”手术和指动脉逆行岛状皮瓣矫正儿童手部甲指骨钩状畸形（临床病例描述）

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详细

论证。钩状畸形是甲指骨损伤后果的常见变异之一。畸形手指除外观可接受外，功能也会丧失。关于儿童这一问题的文献资料很少。本文介绍了一种结合重建技术的钩状畸形手术矫正方案--“触角”手术和指动脉逆行岛状皮瓣--来矫正钩状畸形的手术变体。

临床观察。本文描述了3岁、5岁和17岁患者手部甲指骨创伤后钩状畸形修复的临床病例。所有患者的畸形均通过“触角”手术和指动脉逆行岛状皮瓣联合修复。结果是手指的外观和功能均可接受。

讨论。矫正手指钩状畸形的多种技术已经成熟，文献中的相关数据也证实了这一点。通过观察发现，所述手术方法对所有年龄段的患者都是可靠的。

结论。我们认为，将-“触角”手术与使用指动脉逆行岛状皮瓣在反向血流中创建远端软组织复合体相结合是合理的。不过，这个问题还需要进一步研究。

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作者简介

Alexander V. Alexandrov

Filatov Moscow Children’s Clinical Hospital

Email: alexmicrosurg@mail.ru
ORCID iD: 0000-0002-6110-2380
SPIN 代码: 5229-0038

MD, Head of the Department of Reconstructive Microsurgery

俄罗斯联邦, Moscow

Dmitry Y. Vybornov

Filatov Moscow Children’s Clinical Hospital; Pirogov Russian National Research Medical University

Email: dgkb13@gmail.com
ORCID iD: 0000-0001-8785-7725
SPIN 代码: 2660-5048

MD, PhD, Dr. Sci. (Med.), Professor

俄罗斯联邦, Moscow; Moscow

Pavel V. Goncharuk

Filatov Moscow Children’s Clinical Hospital

Email: goncharukpavel@yandex.ru
ORCID iD: 0000-0002-9560-037X
SPIN 代码: 6801-9875

MD, surgeon

俄罗斯联邦, Moscow

Alexander N. Evdokimov

Filatov Moscow Children’s Clinical Hospital

Email: pediatrix@yandex.ru
ORCID iD: 0000-0002-9113-3612
SPIN 代码: 9432-3519

MD, surgeon

俄罗斯联邦, Moscow

Lamiya Ya. Idris

Pirogov Russian National Research Medical University

Email: idrislamiya@mail.ru
ORCID iD: 0000-0002-4902-7939
SPIN 代码: 1193-7787

MD, PhD student

俄罗斯联邦, Moscow

Alexander A. Smirnov

Filatov Moscow Children’s Clinical Hospital; Pirogov Russian National Research Medical University

Email: smirnov_aan@bk.ru
ORCID iD: 0000-0002-7274-8291
SPIN 代码: 4994-9364

MD, surgeon

俄罗斯联邦, Moscow; Moscow

Ruslan A. Khagurov

Filatov Moscow Children’s Clinical Hospital

Email: dr.khagurov@gmail.com
ORCID iD: 0000-0001-7944-8438

MD, surgeon

俄罗斯联邦, Moscow

Natalya Ye. Alexandrova

Filatov Moscow Children’s Clinical Hospital

编辑信件的主要联系方式.
Email: docnatali1@yandex.ru
ORCID iD: 0009-0008-7269-0289

MD, anesthesiologist

俄罗斯联邦, Moscow

参考

  1. Al-Anazi AF. Fingertip injuries in paediatric patients – experiences at an emergency centre in Saudi Arabia. J Pak Med Assoc. 2013;63(6):675–679.
  2. Patel L. Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care. 2014;30(10):742–745. doi: 10.1097/PEC.0000000000000241
  3. Miller AJ, Rivlin M, Kirkpatrick W, et al. Fingertip amputation treatment: a survey study. Am J Orthop (Belle Mead. NJ). 2015;44(9):E331–E339.
  4. Kumar VP, Satku K. Treatment and prevention of “hook nail” deformity with anatomic correlation. J Hand Surg Am. 1993;18(4):617–620.
  5. Panattoni JB, De Ona IR, Ahmed MM. Reconstruction of fingertip injuries: surgical tips and avoiding complications. J Hand Surg Am. 2015;40(5):1016–1024. doi: 10.1016/j.jhsa.2015.02.010
  6. Hwang E, Park BH, Song SY, et al. Fingertip reconstruction with simultaneous flaps and nail bed grafts following amputation. J Hand Surg Am. 2013;38(7):1307–1314. doi: 10.1016/j.jhsa.2013.03.032
  7. Kusuhara H, Ichinohashi K, Sueyoshi Y, et al. Reconstruction of severely crushed fingertip amputations with basic fibroblast growth factor slow release system. Plast Reconstr Surg Glob Open. 2017;5(6). doi: 10.1097/GOX.0000000000001384
  8. Alexandrov AV, Goncharuk PV, Evdokimov AN, et al. Two clinical cases of the reconstruction of distal phalanges of hand in children by combination of the regional flap and scrap bone and nailbed graft. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2022;10(3):277–284. (In Russ.) doi: 10.17816/PTORS108022
  9. Atasoy E, Godfrey A, Kalisman M. The “antenna” procedure for the “hook-nail” deformity. J Hand Surg Am. 1983;8(1):55–58.
  10. Henderson JT, Schulz SA, Swiergosz AM, et al. Preservation of the sterile matrix, hyponychium, and fingertip pad in fingertip reconstruction with composite fingertip and nail bed graft and volar V-Y advancement flap. Eplasty. 2017;17.
  11. García-López A, Laredo C, Rojas A. Oblique triangular neurovascular osteocutaneous flap for hook nail deformity correction. J Hand Surg Am. 2014;39(7):1415–1458. doi: 10.1016/j.jhsa.2014.04.036
  12. Alexandrov AV, Smirnov AA, Gonchruk PV. Fingertip defects coverage using reverse-flow homodigital island flaps. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(2):221–228. (In Russ.) doi: 10.17816/PTORS57059
  13. Alexandrov AV, Goncharuk PV, Idris LYа, et al. A complex soft tissue reconstruction of distal phalanges in children. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2021;11(1):27–38. (In Russ.) doi: 10.17816/psaic701

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2. Fig. 1. Schematic representation of the correction of the nail phalanx deformity using a combination of the “antenna procedure” and the reverse-flow homodigital island flap

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3. Fig. 2. A 3-year-old girl was diagnosed with posttraumatic deformity of the nail phalanx of finger II of the right hand: a, deformed nail phalanx; b, radiographs of the finger; c, stages of deformity correction; d, appearance of the finger 2 months after the surgery

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4. Fig. 3. A 5-year-old boy was diagnosed with posttraumatic deformity of the nail phalanx of finger II of the right hand: a, deformed nail phalanx; b, radiographs of the finger; c, stages of the surgery for deformity correction; d, appearance of the finger 3 months after the surgery

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5. Fig. 4. A 16-year-old girl was diagnosed with posttraumatic deformity of the nail phalanx of finger II of the right hand: a, deformed nail phalanx; b, radiographs of the finger; c, stages of the surgery for deformity correction; d, appearance of the finger 5 months after the surgery

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