Molski M
Klinika Chirurgii Plastycznej, Centrum Medycznego Kształcenia Podyplomowego w Warszawie.
Chir Narzadow Ruchu Ortop Pol. 2000;65(4):375-82.
A reverse flow pedicled osteo-fascio-cutanous radial forearm flap was applied in different clinical situations. Treatment of 1 female patient--age 28 years, and 3 male patient--age 17, 29 and 33 years is presented. Indications for treatment were: congenital malformation of the thenar region and thumb, deficit of the soft tissue, of the IMP joint and a segment of the first metacarpal bone, amputation of the thumb at IMP level and congenital total absence of the first ray of the hand. The author's modification of total thumb reconstruction is presented. Some steps of the procedure, using osteo-fascio-cutaneous radial flap differed from the original Biemer and Stock method. Donor site was located on the medial and radial part of the forearm. The flap was planned, elevated longitudinally and folded over the vascularized radial bone graft. In thumb reconstruction cases no implants were used for bone fixation. Part of the radius was directly nailed into the distal part of the first metacarpal. Bone healing was observed after 6 weeks and its remodeling took nearly 6 months. There were no complications at the donor site (one was closed directly and two by skin grafts). Two flaps were remodeled because of soft tissue abundance. Functional and cosmetic results were good in all four cases.
应用逆行带蒂骨-筋膜-皮瓣桡侧前臂皮瓣治疗不同临床情况。本文介绍了1例28岁女性患者及3例男性患者（年龄分别为17岁、29岁和33岁）的治疗情况。治疗适应证包括：鱼际区和拇指先天性畸形、软组织缺损、指间关节和第一掌骨部分缺损、拇指指间关节水平截肢以及手部第一掌骨先天性完全缺如。介绍了作者对全拇指再造的改良方法。使用骨-筋膜-皮瓣桡侧皮瓣的手术步骤与原始的比默尔和斯托克方法有所不同。供区位于前臂内侧和桡侧。皮瓣按计划纵向掀起，覆盖在带血管的桡骨移植骨上。在拇指再造病例中，未使用植入物进行骨固定。部分桡骨直接钉入第一掌骨远端。6周后观察到骨愈合，其重塑过程近6个月。供区无并发症（1例直接缝合，2例植皮）。2例皮瓣因软组织过多进行了重塑。4例患者的功能和美容效果均良好。
