Lin Cheng-Hung, Lin Yu-Te, Sassu Paolo, Lin Chih-Hung, Wei Fu-Chan
Taipei, Taiwan From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, and Chang Gung University.
Plast Reconstr Surg. 2007 Oct;120(5):1315-1321. doi: 10.1097/01.prs.0000279476.29055.5f.
Posttraumatic fingertip reconstruction with free toe pulp transfer was first described in 1979. Several studies have tested the sensibility of the reconstructed digits using the two-point discrimination test. The goal of this study was to comprehensively assess the functional outcome of the reconstructed fingertips after free toe pulp transfer.
There were 15 flaps in 14 male patients in this retrospective study. Objective sensory recovery was assessed with two-point discrimination and Semmes-Weinstein monofilament tests. Pinch power of the reconstructed digits and subjective pain and discomfort were also evaluated.
Six flaps had good results, six had fair results, and three could perceive only one point. The Semmes-Weinstein monofilament test revealed diminished light touch in six flaps, diminished protective sensation in eight flaps, and loss of protective sensation in one flap. There was strong correlation between static and moving two-point discrimination (gamma = 0.78747, p = 0.0005) but weak correlation between static two-point discrimination and the Semmes-Weinstein monofilament test (gamma = 0.34240, p = 0.2116). There was a significant difference in static two-point discrimination (p < 0.01) but no significant difference in Semmes-Weinstein results between the contralateral toes and flaps. The mean difference in pinch power between the dominant and nondominant hands was 6.72 percent with involvement of the dominant hand and 34.16 percent with involvement of the nondominant hand. There was no significant difference between the pinch power of the reconstructed digits and adjusted values.
After free toe pulp transfer, the reconstructed digits had equal sensory threshold as the donor toes, but functional sensibility varied. Pinch power was restored. Free toe pulp transfer restored the sensibility, stability, and durability of the finger pulp and achieved functional recovery of the traumatized digits.
1979年首次报道了采用游离趾腹移植进行创伤后指尖重建。多项研究使用两点辨别试验测试了重建手指的感觉功能。本研究的目的是全面评估游离趾腹移植后重建指尖的功能结局。
本回顾性研究纳入了14例男性患者的15个皮瓣。采用两点辨别试验和Semmes-Weinstein单丝试验评估客观感觉恢复情况。还评估了重建手指的捏力以及主观疼痛和不适情况。
6个皮瓣效果良好，6个效果一般，3个只能感知一个点。Semmes-Weinstein单丝试验显示，6个皮瓣轻触觉减退，8个皮瓣保护性感觉减退，1个皮瓣保护性感觉丧失。静态和动态两点辨别试验之间存在强相关性（γ = 0.78747，p = 0.0005），但静态两点辨别试验与Semmes-Weinstein单丝试验之间相关性较弱（γ = 0.34240，p = 0.2116）。对侧脚趾与皮瓣之间在静态两点辨别试验方面存在显著差异（p < 0.01），但在Semmes-Weinstein试验结果方面无显著差异。优势手受累时，优势手与非优势手之间捏力的平均差异为6.72%，非优势手受累时为34.16%。重建手指的捏力与校正值之间无显著差异。
游离趾腹移植后，重建手指的感觉阈值与供体脚趾相同，但功能感觉存在差异。捏力得以恢复。游离趾腹移植恢复了指腹的感觉、稳定性和耐用性，实现了创伤手指的功能恢复。
