Peimer C A, Alexander M
Department of Orthopaedic Surgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York.
Hand Clin. 1990 Nov;6(4):607-15.
Selection of the most appropriate operations for a patient is as important as technical expertise in performing the procedures. Web deepening may be performed alone or in addition to tissue augmentation and should be planned in conjunction with bone lengthening. Skeletal augmentation is useful if fingers are missing or inadequate, and it is necessary to add bony tissue. In general, in order to grow, skeletal transfers must be performed on very young children or must include vascularized physes; complex cases may require microvascular composite toe-to-hand transfer. Distraction-lengthening for intercalary skeletal enhancement is indicated for patients with multiple hypoplastic, aplastic, and missing digits, but the cosmetic result is limited. The major procedures should be started by age 2 years and finished by age 4; unfortunately, it is most often not advisable to perform microvascular surgery at such an early age. Modification of functional patterns, even though they are abnormal or the result of incomplete anatomy, should be avoided in the older child or adult because tinkering does not lead to significant benefits. For a cooperative, and often difficult, staged venture to be maximally successful, physicians and parents must share realistic expectations of aesthetic and functional results.
为患者选择最合适的手术与实施手术的技术专长同样重要。蹼加深可单独进行，也可在组织增大术之外进行，且应与骨延长术协同规划。如果手指缺失或发育不全且有必要添加骨组织，骨骼增大术是有用的。一般来说，为了实现生长，骨骼移植必须在非常年幼的儿童身上进行，或者必须包含带血管的骨骺；复杂病例可能需要进行微血管复合足趾到手的移植。对于多个发育不全、发育不良和缺失手指的患者，可采用牵张延长术进行节段性骨骼增强，但美容效果有限。主要手术应在2岁时开始，4岁时完成；不幸的是，在这么小的年龄进行微血管手术通常是不可取的。对于年龄较大的儿童或成人，应避免改变功能模式，即使这些模式是异常的或解剖结构不完整的结果，因为修补不会带来显著益处。为了使一项合作性强且往往困难的分阶段治疗取得最大成功，医生和家长必须对美学和功能结果抱有现实的期望。
