전외측 대퇴부 유리피판술 이용한 제1수지간 반흔구축 재건 (Anterolateral Thigh Flap for 1st Web Contracture Release)

서지정보

· 발행기관 : 대한성형외과학회
· 수록지 정보 : Archives of Plastic Surgery / 36권 / 2호 / 147 ~ 152페이지
· 저자명 : 김기완, 이동철, 김진수, 기세휘, 노시영, 양재원

초록

Purpose: First web space contracture of the hand has been treated with various surgical techniques such as Z-plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture.
Methods: From August 2003 to September 2007, the authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and the authors performed photographic analysis of the thumb abduction angle of postoperative increase.
Results: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split-thickness skin graft in 1 case. Average flap size was 8×9cm and average thickness was 0.6cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of 34.7° in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z-plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases.
Conclusion: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.

영어초록

Purpose: First web space contracture of the hand has been treated with various surgical techniques such as Z-plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture.
Methods: From August 2003 to September 2007, the authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and the authors performed photographic analysis of the thumb abduction angle of postoperative increase.
Results: All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split-thickness skin graft in 1 case. Average flap size was 8×9cm and average thickness was 0.6cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of 34.7° in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z-plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases.
Conclusion: In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.

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