복합피부조직이식술을 이용한 외상성 수지만곡증의 교정

Abstract

The electrical burn or amputation of fingers gives damages not only to the soft tissue, but also to the bone, tendon and joint structure and causes severe deformity. To correct severe deformity, surgeons perform osteoplasty, tenolysis, capsulotomy, arthro- plasty, and flap surgery. However, such surgery can not be performed under some circumstances because patients wish to undergo surgery step-by-step, in stead of taking all at once. The deformity would have been more severe if the corrective surgery had been delayed without any treatment. The authors have reconstructed only soft tissue using the preserved superficial fat skin graft taken from the medial side of the foot or great toe. Nine patients who had deviated fingers were corrected from June 2001 to June 2002. Seven patients had deformity due to electrical burn, one due to amputation and the other due to congenital syndactyly. The period of follow-up was from 19 to 31 months. At surgery, a skin incision on the scar vertical to the finger and release of contraction of the deviated finger was performed. The soft tissue defect was reconstructed with a composite graft taken from medial side of the foot or great toe, with a preserved superficial fat layer. To accelerate healing of the grafted tissue, antibiotic ointment was applied to preserve the moisture environment. The composite graft was well taken without complication, and especially, there was no necrosis although the composite tissue was as big as 18x15mm to 33x11mm. The preoperative deformity was corrected better than we expected after surgery. The color and tissue texture were excellent and well harmonized with the surrounding skin, and the donor site healed without complication. We also observed a new bone formation in some cases.