Nisanci Mustafa, Eski Muhitdin, Isik Selcuk
Gülhane Military Medical Academy, Plastic, Reconstructive and Aesthetic Surgery, Department and Burn Center-Ankara, Turkey.
J Burn Care Res. 2008 Jul-Aug;29(4):666-70. doi: 10.1097/BCR.0b013e31817db97a.
Treatment of postburn deformities of the hand is a real challenge to reconstructive surgeons. A functional reconstruction was achieved with two sensate island flaps on two discrete pedicles in a case with severe postburn deformity involving both thumb and index finger. Surgical treatment was based on amputation of the second ray and reconstruction of the thumb with the flaps derived from the discarded index finger. Two sensate island flaps on two discrete pedicles, "1st dorsal metacarpal artery based flap" from the dorsal aspect of the proximal phalanx and "palmar digital artery based fillet flap" composed of available volar skin of the index finger distal to contracture, were harvested and used for replacement of the soft tissue defect of the thumb that appeared after correction of bone and joint deformities. Both of the flaps survived and functional improvement was satisfactory at one-year follow-up. Despite the shortening of neurovascular bundles due to severe flexion deformity, a sensate thumb reconstruction with a better tissue match was achieved thanks to more beneficial design and orientation of two neorovascular island flaps from a deformed index finger. Instead of a single fillet flap design in its common use, our current approach allowed more beneficial use of a discarded index finger in severe postburn deformity involving both thumb and index finger.
手部烧伤后畸形的治疗对重建外科医生来说是一项真正的挑战。在一例涉及拇指和示指的严重烧伤后畸形病例中，通过两个独立蒂的感觉岛状皮瓣实现了功能重建。手术治疗基于切除第二掌骨并利用废弃示指的皮瓣重建拇指。从近端指骨背侧切取两个独立蒂的感觉岛状皮瓣，即“第一掌背动脉蒂皮瓣”，以及由挛缩远端示指掌侧可用皮肤组成的“指掌侧动脉蒂鱼际皮瓣”，用于修复矫正骨与关节畸形后出现的拇指软组织缺损。两个皮瓣均存活，随访一年时功能改善令人满意。尽管由于严重的屈曲畸形导致神经血管束缩短，但得益于从畸形示指设计并定向更有利的两个神经血管岛状皮瓣，实现了组织匹配更好的有感觉拇指重建。与常用的单一鱼际皮瓣设计不同，我们目前的方法能在涉及拇指和示指的严重烧伤后畸形中更有效地利用废弃示指。
