Oishi Scott N, Ezaki Marybeth
Texas Scottish Rite Hospital for Children, St. Dallas, TX 75219, USA.
Tech Hand Up Extrem Surg. 2010 Jun;14(2):104-7. doi: 10.1097/BTH.0b013e3181d4459d.
Volkmann ischemic contracture is a devastating injury, which can lead to severe dysfunction of the upper extremity in the pediatric population. This can result in an insensate hand with minimal finger motion and use. Before the inciting injury this is usually a normal upper extremity. Patients with severe contractures require complex reconstruction that use either tendon transfers or free functioning muscle transfer. Many times the wrist extensors are not available as tendon transfers because of their involvement in the initial process. At our institution, we took a 2-stage approach to this difficult problem, which involves initial muscle debridement and neurolysis followed by second-stage free functioning muscle transfer after return of sensation and intrinsics to the hand. We feel that this optimizes our result in the patients with severe Volkmann ischemic contracture. We present our technique for 2-stage reconstruction using free functioning muscle transfer in the pediatric patient.
Volkmann缺血性挛缩是一种严重的损伤，可导致小儿上肢严重功能障碍。这可能导致手部感觉丧失，手指活动和使用能力极小。在引发损伤之前，上肢通常是正常的。严重挛缩的患者需要进行复杂的重建手术，采用肌腱转移或游离功能性肌肉转移。由于腕伸肌在初始过程中受累，很多时候无法作为肌腱转移使用。在我们机构，我们采用两阶段方法来解决这个难题，第一阶段包括初始的肌肉清创和神经松解，然后在手部恢复感觉和内在肌功能后进行第二阶段的游离功能性肌肉转移。我们认为这能优化严重Volkmann缺血性挛缩患者的治疗效果。我们介绍在小儿患者中使用游离功能性肌肉转移进行两阶段重建的技术。
