Sabapathy S Raja, Venkatramani Hari, Bhardwaj Praveen
Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, 641043, India.
Department of Plastic Surgery, Hand Surgery, Reconstructive Microsurgery and Burns, Ganga Hospital, 313 Mettupalayam Road, Coimbatore, 641043, India.
Injury. 2013 Mar;44(3):370-5. doi: 10.1016/j.injury.2013.01.012. Epub 2013 Jan 20.
Traumatic loss of thumb at the carpometacarpal (CMC) joint level is very disabling to an individual. Pollicisation is the recommended technique of reconstruction for loss of thumb at this level. On occasions, injury to the rest of the hand or amputation of additional fingers may make pollicisation an impossible option. Microsurgical transfer of second toe is an option in such situations. Although many large series of toe transfers are available in the literature, no series deals exclusively with this subset of patients.
Eight patients who had amputation of the thumb at or proximal to the CMC joint level were reconstructed by second toe transfer by us in the period 2002-2011. All had preliminary groin flap cover in the area of the thumb during the acute stage of treatment. Second toe with the metatarsal was transferred for thumb reconstruction after a mean duration of 3 months after flap cover. Patients were assessed for their ability to pinch, hold large objects and opposition achieved by Kapandji score. Average follow up is 4 years and 6 months with a minimum of 1 year.
All toe transfers survived. They reached their maximum functional potential by 1 year. All patients actively used the reconstructed thumb for day to day activities. Pinch was possible in all patients except two patients who did not have any fingers. Six of them registered grip strength of at least 50% of the opposite hand. When fingers were present, opposition was possible in all patients with Kapandji scores ranging from 5 to 8. Extent of usage was less in patients who did not have good function in other fingers.
Second toe transfer is a viable option for reconstruction of thumb loss at or proximal to the CMC joint level. Proper planning of the preliminary flap cover determines the length of the thumb reconstruction. Strategic position of the transferred toe of adequate length and the functional status of the other fingers are important determinants of functional outcome.
拇指在掌指关节（CMC）水平的创伤性缺失对个体功能影响极大。拇指再造术是该水平拇指缺失的推荐重建技术。然而，手部其他部位的损伤或额外手指的截肢有时会使拇指再造术无法实施。在这种情况下，显微外科第二足趾移植是一种选择。尽管文献中有许多关于足趾移植的大型系列报道，但尚无专门针对这类患者的系列研究。
2002年至2011年期间，我们对8例拇指在掌指关节或其近端水平截肢的患者进行了第二足趾移植再造术。所有患者在治疗急性期均接受了腹股沟皮瓣覆盖拇指区域。皮瓣覆盖后平均3个月，将带跖骨的第二足趾移植用于拇指再造。通过卡潘迪评分评估患者的捏物、握持大物体及对掌功能。平均随访时间为4年6个月，最短随访时间为1年。
所有足趾移植均存活。1年后它们达到了最大功能潜力。所有患者均积极使用再造拇指进行日常活动。除2例无其他手指的患者外，所有患者均能进行捏物动作。其中6例患者的握力至少达到对侧手的50%。当有其他手指时，所有患者均能进行对掌动作，卡潘迪评分在5至8分之间。其他手指功能不佳的患者，再造拇指的使用程度较低。
第二足趾移植是掌指关节或其近端水平拇指缺失再造的可行选择。初步皮瓣覆盖的合理规划决定了拇指再造的长度。移植足趾的合适长度及位置以及其他手指的功能状态是功能结果的重要决定因素。
