网络空间脚趾丝状瓣:用于两个相邻脚趾非对称截肢后伤口闭合的变体趾丝瓣

K. Yammine, J. Mouawad, Youssef Jamaleddine
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摘要

因趾骨近端延伸至跖趾关节的血管坏死而截趾,截趾后的伤口闭合可能具有挑战性。当坏死不对称地累及相邻的两个脚趾时,部分坏死脚趾的健康组织可用作截肢后手术伤口闭合的备用部分。本文报告了一种趾丝状皮瓣的变体,即蹼间隙趾丝状皮瓣,在临床上遇到这种情况时可以使用。在截除跖趾关节处完全坏死的脚趾后,切除部分坏死脚趾的坏死部分,同时保留所有近端健康的软组织,包括神经血管。因此,闭合是通过轴向模式数字皮瓣而不是随机皮瓣来实现的。在某些情况下,当坏死较远时,可以保留近端指骨,并将其用作蹼间隙的间隔物,这样可能会避免剩余脚趾的侧向抓挠。蹼间隙趾丝状瓣可以很好地解决两个相邻脚趾非对称截肢后的伤口闭合问题。证据等级:第五级,专家意见。
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The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes
Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes. Levels of Evidence: Level V, expert opinion.
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