Louisville, Ky.; Cangzhou, China; and Kuala Lumpur, Malaysia From the Christine M. Kleinert Institute for Hand and Microsurgery, the Kleinert Kutz Hand Care Center, and the Department of Surgery, School of Medicine, University of Louisville, the Department of Hand Surgery, Hebei Province Medical University, and the Hand Unit, Medical Faculty, Universiti Kebangsaan Malaysia.
Plast Reconstr Surg. 2010 Dec;126(6):2052-2059. doi: 10.1097/PRS.0b013e3181f44994.
Second toe-to-thumb transfer is a good alternative to using the great toe for reconstruction of the thumb. It achieves excellent function and reduces morbidity to the donor foot. However, cosmesis is often poor. The second toe has three unattractive features, a narrow "neck," a bulbous tip, and a short nail.
The authors describe a modified second toe transfer that addresses cosmesis in six patients. These include (1) harvesting a flap from the adjacent side of the great toe and insetting it into the volar aspect of the second toe to give more bulk, (2) making skin excisions on each side of the tip to reduce the bulbous appearance, and (3) excising the eponychium to produce apparent lengthening of the nail.
The mean follow-up period was 18 months (range, 6 to 36 months). The procedure resulted in good function and improved cosmesis in all six cases. Part of the great toe flap was lost in one case. The mean two-point discrimination in the transferred toes was 10.1 mm, with protective sensation present in the flaps. The range of motion of the transferred toe was 14 to 38 degrees at the metatarsophalangeal joint, 16 to 55 degrees at the proximal interphalangeal joints, and 20 to 36 degrees in the distal interphalangeal joints. All patients except one were happy with the appearance of the transferred toe.
This novel approach will allow patients to take advantage of the lower morbidity to the donor site afforded by second toe-to-thumb transfer and provide the patients with a more aesthetic appearance of the new thumb.
第二趾-拇指转移是重建拇指的一种很好的选择，它可以实现出色的功能，并减少供足的发病率。然而，美容效果往往较差。第二趾有三个不吸引人的特征，即“颈部”狭窄、末端呈球状和指甲短。
作者描述了一种改良的第二趾转移术，可改善 6 例患者的美容效果。这些方法包括：（1）从大脚趾的相邻侧取皮瓣，嵌入第二趾的掌侧，以增加体积；（2）在末端的每侧做皮肤切口，以减少球状外观；（3）切除甲上皮，使指甲看起来明显变长。
平均随访时间为 18 个月（6 至 36 个月）。所有 6 例患者的手术均取得了良好的功能和改善的美容效果。一例患者部分大脚趾皮瓣丢失。转移趾的两点辨别觉平均为 10.1mm，皮瓣有保护性感觉。转移趾的跖趾关节活动度为 14 至 38 度，近节指间关节为 16 至 55 度，远节指间关节为 20 至 36 度。除 1 例患者外，所有患者均对转移趾的外观感到满意。
这种新方法将使患者能够利用第二趾-拇指转移术对供区较低的发病率优势，并为患者提供更美观的新拇指外观。
