Vaienti L, Zilio D, Ravasio G, Gazzola R, Marchesi A
UO di Chirurgia Plastica , Dipartimento di ScienzeMedico Chirurgiche, I.R.C.C.S. Policlinico San Donato, Milano.
Pediatr Med Chir. 2009 Nov-Dec;31(6):258-61.
We have examined 11 patients with aplasia of the thumb and we have treated by pollicization of the index finger. We have conducted a follow up of 5 years. The total absence of the thumb may be an isolated anomaly, but it is often associated with some other congenital malformation. The absent thumb is as an autosomal dominant pathology or may be sporadic. It is frequently observed in the Holt-Oram syndrome, Fanconi's anemia, and ring D chromosome abnormalities. It is occasionally observed in the Rothmund syndrome, trisomy, thalidomide embryopathology and other congenital syndromes. An absent radius is almost always associated with an absent thumb, except in thrombocytopenia radial aplasia (Fanconi's syndrome), where the thumb is present even when the radius is absent. The treatment in most cases of the absent thumb is to perform a pollicization of the index finger. Our isolated congenital absence of the thumb patients have been treated with pollicization as described by Buck-Gramcko works well. It is a beautiful operation for the congenitally deformed, aplastic, or missing thumb. Pollicization of the index finger gives good functional and cosmetic results which are maintained.
The total absence of the thumb in the congenitally pathology gives the hand of the patient insufficient in the functional movement and no cosmetic. So the pollicization with the second index fined gives a good reconstruction for the neo-thumb. In our five years follow-up, the 11 young patients that were treated with the pollicization, they are satisfy and use the neo-thumb like normal thumb. In congenitally absent thumbs clearly support the fact that the pollicized digit is used by most patients and is not ignored or bypassed.
我们检查了11例拇指缺如患者,并通过食指拇指化进行治疗。我们进行了5年的随访。拇指完全缺如可能是一种孤立的异常,但通常与其他一些先天性畸形有关。拇指缺如是一种常染色体显性病理特征,也可能是散发性的。它常见于霍尔特-奥勒姆综合征、范科尼贫血和D环染色体异常。偶尔也见于罗思蒙德综合征、三体综合征、沙利度胺胚胎病变及其他先天性综合征。除了血小板减少性桡骨发育不全(范科尼综合征)外,桡骨缺如几乎总是与拇指缺如相关,在该综合征中即使桡骨缺如拇指仍存在。大多数拇指缺如病例的治疗方法是进行食指拇指化。我们的孤立性先天性拇指缺如患者已按照巴克-格拉姆科描述的方法进行拇指化治疗,效果良好。对于先天性畸形、发育不全或缺失的拇指来说,这是一种很好的手术方法。食指拇指化能带来良好的功能和美观效果,且效果持久。
先天性病理状态下拇指完全缺如会使患者手部功能运动不足且不美观。因此,用第二指进行拇指化可为新拇指提供良好的重建。在我们的五年随访中,接受拇指化治疗的11名年轻患者感到满意,他们像使用正常拇指一样使用新拇指。先天性拇指缺如清楚地支持了这样一个事实,即大多数患者会使用拇指化的手指,而不会忽视或不用它。