Lai Ching-Hung, Lai Chung-Sheng, Huang Shu-Hung, Lin Sin-Daw, Chang Kao-Ping
Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Ann Plast Surg. 2010 Dec;65(6):535-40. doi: 10.1097/SAP.0b013e3181d376df.
Destruction of the thumb secondary to trauma presents a much more significant influence on daily living than do injuries to the other digits. Various surgical techniques contribute to repair distal defects of the fingers, especially thumb reconstruction.
Seven patients received free medial plantar artery perforator (MPAP) flaps to resurface the palmar defects of their thumbs. The flaps can be harvested with or without the main trunk of the medial plantar artery. The perforator of the MPAP flap was anastomosed to a proper digital artery, and the superficial vein of the flap was anastomosed to the dermal vein of the injured finger. These thumbs had no severe length discrepancy or metacarpophalangeal joint injuries. All patients underwent examinations including static 2-point discrimination, moving 2-point discrimination, and Semmes-Weinstein Test Score 6 months after reconstructive surgery. All tests were carried out by the same occupational therapist 6 months after reconstructive surgery.
Five male and 2 female patients were selected for free MPAP flap reconstruction from May 2006 to September 2007. The mobility of the fingers was not restricted after surgery. Six flaps survived completely, and 1 flap partially failed because of venous congestion. Sensory restoration was ideal for all 7 MPAP flaps.
The MPAP flap is a suitable choice for reconstructing palmar defects of the fingers, with less donor site morbidity. The cushiony character of the MPAP flap is anatomically similar to the pulp tissue of fingers, and sensory restoration is ideal compared with that of other reconstructive methods. Technical difficulty is focused on anastomosis of perforators (diameter ≤0.8 mm).
创伤导致的拇指毁损对日常生活的影响远比对其他手指损伤的影响大得多。多种外科技术有助于修复手指远端缺损，尤其是拇指再造。
7例患者接受了游离足底内侧动脉穿支（MPAP）皮瓣修复拇指掌侧缺损。该皮瓣可在保留或不保留足底内侧动脉主干的情况下切取。将MPAP皮瓣的穿支与合适的指动脉吻合，皮瓣的浅静脉与伤指的真皮静脉吻合。这些拇指无严重的长度差异或掌指关节损伤。所有患者在重建手术后6个月接受了包括静态两点辨别觉、动态两点辨别觉和Semmes-Weinstein测试评分在内的检查。所有检查均在重建手术后6个月由同一名职业治疗师进行。
2006年5月至2007年9月，选择5例男性和2例女性患者进行游离MPAP皮瓣重建。术后手指活动不受限。6个皮瓣完全存活，1个皮瓣因静脉淤血部分坏死。所有7个MPAP皮瓣的感觉恢复均理想。
MPAP皮瓣是修复手指掌侧缺损的合适选择，供区并发症较少。MPAP皮瓣的质地在解剖学上与手指的指腹组织相似，与其他重建方法相比，感觉恢复理想。技术难点在于穿支（直径≤0.8mm）的吻合。
