Mutaf Mehmet, Temel Metin, Günal Ertan, Işık Dağhan
Department of Plastic and Reconstructive Surgery, Gaziantep University School of Medicine, Gaziantep, Turkey.
Ann Plast Surg. 2012 Feb;68(2):153-7. doi: 10.1097/SAP.0b013e318216e6b1.
The volar advancement flap of the thumb described by Moberg has been used for pulp defects up to 1 to 1.5 cm since its mobility is quite limited due to the stiff nature and fibrous connections of the regional skin with underlying structures. There have been several attempts to increase the mobility of this useful flap by adding V-Y and Z-plasty concepts into the technique. These modifications could provide a slight increase in the flap advancement and achieve closure of defects up to 2 cm in length at best.
In this study, we describe the island volar advancement flap of the thumb in which all attachments, except the neurovascular pedicle of the flap, were divided to provide maximum mobility and advancement. This technique was used in 12 patients for reconstruction of traumatic defects of the distal thumb up to 3 to 3.5 cm in length.
The flaps healed uneventfully in all patients. There was no patient with flap failure. All patients were followed up for 2 to 6 years (4 years on an average). Our results revealed sensible and durable skin coverage with maximum preservation of the thumb length.
The island volar advancement flap seems to be a safe and useful procedure for thumb reconstruction. Providing a 1.5 cm of extra flap advancement, this new procedure enables us 1-stage closure of considerably large defects and is a critical achievement in thumb reconstruction.
莫伯格描述的拇指掌侧推进皮瓣自问世以来，一直用于修复长达1至1.5厘米的指腹缺损，因为该区域皮肤与深层结构之间质地僵硬且存在纤维连接，导致其活动度相当有限。人们曾多次尝试通过在该技术中加入V - Y和Z成形术的理念来增加这种实用皮瓣的活动度。这些改良方法最多能使皮瓣推进略有增加，并实现对长达2厘米缺损的闭合。
在本研究中，我们描述了一种拇指岛状掌侧推进皮瓣，除皮瓣的神经血管蒂外，将所有附着部分离，以提供最大的活动度和推进距离。该技术应用于12例患者，用于修复长度达3至3.5厘米的拇指远端创伤性缺损。
所有患者的皮瓣均顺利愈合。无皮瓣坏死病例。所有患者均随访2至6年（平均4年）。结果显示，皮瓣覆盖感觉良好且持久，最大限度地保留了拇指长度。
岛状掌侧推进皮瓣似乎是一种安全有效的拇指重建手术方法。这种新方法能使皮瓣多推进1.5厘米，使我们能够一期闭合相当大的缺损，这是拇指重建中的一项重大成果。
