Ozkan Türker, Kuvat Samet Vasfi, Aydin Atakan, Biçer Ahmet
Istanbul Universitesi Istanbul Tip Fakültesi Plastik Rekonstrüktif ve Estetik Cerrahi Anabilim Dali El Cerrahisi Bilim Dali.
Acta Orthop Traumatol Turc. 2007;41(1):36-41.
Free transfer of the toe phalanges to the hand without vascular anastomosis is a proposed option for reconstruction of congenital aphalangia. We evaluated the growth behavior of the phalanges in patients after transfer.
Six patients with congenital aphalangia underwent 18 nonvascular phalangeal transfers from toes to the hand. The anomaly was bilateral in one patient. Except for one patient who was 11.5 years old, the mean age at the time of surgery was 27 months (range 14 to 48 months). The patients were followed-up for a mean of 2.5 years (range 2 to 4 years) with respect to functional results, yearly longitudinal growth, epiphysial closure, bone resorption or necrosis, digital tip necrosis, fracture, angulation, subluxation, infections, and donor site morbidity.
The mean yearly longitudinal growth rate of transferred phalanges was 2.4 mm. On final radiographic examinations, epiphysial closure was not completed in 14 phalanges (78%). Functional improvements included stabilization using the affected digit in three patients, and performing further movements in three patients. One patient underwent reoperation for postoperative subluxation. No fractures or angulation above 15 degrees were seen. Bone resorptions were partial in three patients (16%), and total in one patient (5%). Concerning soft tissue complications, digital tip necrosis developed in one patient (5%). No infections were encountered during the follow-up. All the patients exhibited minimal donor digit shortening.
Nonvascular phalangeal transfer is an alternative rehabilitation method by which use of prosthetics may be facilitated and functional capacity may be increased in congenital hand anomalies such as congenital aphalangia, in which vascular phalanx transfer is not suitable.
将趾骨无血管吻合地游离移植至手部是一种用于先天性无指畸形重建的提议方案。我们评估了移植后患者趾骨的生长行为。
6例先天性无指畸形患者接受了18次从趾部到手部的非血管化趾骨移植。1例患者为双侧畸形。除1例患者年龄为11.5岁外，手术时的平均年龄为27个月（范围14至48个月）。对患者进行了平均2.5年（范围2至4年）的随访，内容包括功能结果、每年的纵向生长、骨骺闭合、骨质吸收或坏死、指尖坏死、骨折、成角、半脱位、感染以及供区并发症。
移植趾骨的平均每年纵向生长速率为2.4毫米。在最终的影像学检查中，14根趾骨（78%）的骨骺未完全闭合。功能改善包括3例患者使用患指实现稳定，3例患者能够进行更多动作。1例患者因术后半脱位接受了再次手术。未发现骨折或成角超过15度的情况。3例患者（16%）出现部分骨质吸收，1例患者（5%）出现完全骨质吸收。关于软组织并发症，1例患者（5%）发生了指尖坏死。随访期间未发生感染。所有患者的供趾缩短均很轻微。
非血管化趾骨移植是一种替代性康复方法，对于诸如先天性无指畸形这类不适合血管化趾骨移植的先天性手部畸形，该方法可便于使用假肢并提高功能能力。
