Foucher G, Medina J, Navarro R
J Reconstr Microsurg. 2001 Jan;17(1):9-15. doi: 10.1055/s-2001-12683.
If a classically hypoplastic thumb, type IIIA, presenting with a first carpometacarpal joint, is amenable to reconstruction, a type IIIB case without the basal joint, is classically treated by pollicization. The authors concur with this opinion, but found two circumstances in which reconstruction is an option in a type IIIB thumb, either when an adolescent asks for improvement of an unstable but utilized thumb, or when a parent definitely refuses pollicization. In such cases, a free, vascularized metatarsophalangeal joint is the first step of the reconstruction, followed by classic non-microsurgical steps. The authors reviewed five cases, with a mean follow-up of 7.8 years. Hypoplasia of the reconstructed thumb, and a limited pinch, allow this option only with restricted indications.
如果是典型的发育不全拇指，ⅢA型，伴有第一腕掌关节，适合进行重建；而没有基底关节的ⅢB型病例，传统上通过拇指化进行治疗。作者认同这一观点，但发现有两种情况ⅢB型拇指可以选择重建，一是青少年要求改善虽不稳定但仍在使用的拇指，二是家长坚决拒绝拇指化。在这种情况下，游离带血管的跖趾关节是重建的第一步，随后是传统的非显微外科步骤。作者回顾了5例病例，平均随访7.8年。重建拇指的发育不全以及捏力受限，使得这种选择仅适用于特定的适应证。
