Kumta Samir M
Lilavati, Shushrusha and Jaslok Hospitals, Mumbai, Maharashtra, India.
Indian J Plast Surg. 2013 May;46(2):294-302. doi: 10.4103/0970-0358.118608.
The history of thumb reconstruction parallels the history of hand surgery. The attributes that make the thumb unique, and that the reconstructive surgeon must assess and try to restore when reconstructing a thumb, are: Position, stability, strength, length, motion, sensibility and appearance. Deficiency in any of these attributes can reduce the utility of the reconstructed thumb. A detailed assessment of the patient and his requirements needs to be performed before embarking on a thumb reconstruction. Most unsatisfactory results can be attributed to wrong choice of procedure. Component defects of the thumb are commonly treated by tissue from adjacent fingers, hand or forearm. With refinements in microsurgery, the foot has become a major source of tissue for component replacement in the thumb. Bone lengthening, osteoplastic reconstruction, pollicisation, and toe to hand transfers are the commonest methods of thumb reconstruction. Unfavourable results can be classified as functional and aesthetic. Some are common to all types of procedures. However each type of reconstruction has its own unique set of problems. Meticulous planning and execution is essential to give an aesthetic and functionally useful thumb. Secondary surgeries like tendon transfers, bone grafting, debulking, arthrodesis, may be required to correct deficiencies in the reconstruction. Attention needs to be paid to the donor site as well.
拇指再造的历史与手外科的历史并行。使拇指独特的特征，也是重建外科医生在再造拇指时必须评估并试图恢复的特征包括：位置、稳定性、力量、长度、活动度、感觉和外观。这些特征中任何一个的缺失都会降低再造拇指的效用。在着手进行拇指再造之前，需要对患者及其需求进行详细评估。大多数不满意的结果可归因于手术方法选择错误。拇指的部分缺损通常用来自相邻手指、手部或前臂的组织进行治疗。随着显微外科技术的改进，足部已成为拇指部分组织替代的主要组织来源。骨延长、骨成形重建、拇指化和足趾移植到手是最常见的拇指再造方法。不良结果可分为功能和美观方面的。有些是所有类型手术共有的。然而，每种类型的再造都有其独特的一系列问题。精心的规划和执行对于造出一个美观且功能良好的拇指至关重要。可能需要进行二期手术，如肌腱转移、植骨、减容、关节固定术等来纠正再造中的缺陷。同时也需要关注供区。
