Choo J, Sparks B, Kasdan M, Wilhelmi B
Division of Plastic Surgery, University of Louisville.
University of Louisville Medical School.
Eplasty. 2015 Feb 24;15:e5. eCollection 2015.
We report a case in which an avulsion-amputation of the thumb proximal to the lunula was repaired by reattaching the amputated segment as a composite graft. The graft demonstrated complete survival with only a minimal sacrifice in length.
A 23-year-old man presented 4 hours after an avulsion injury of the thumb with associated distal and proximal phalanx fractures. The amputated segment included the sterile and germinal matrix. He underwent defatting and composite grafting of the amputated segment followed by K-wire fixation of his proximal phalanx fracture.
In his 1-week follow-up, the patient's composite graft-including his nail bed-demonstrated complete survival. At one month, the composite graft maintained stable soft tissue coverage and showed signs of nail plate regrowth. Four months after repair, he was able to return to light duty and was advanced to full duty within 5 months. He continued to report gradually improving hypersensitivity at the margins of the graft and stiffness of the interphalangeal joint. At five months he regained full mobility of his carpometacarpal joint. The range of motion of his interphalangeal and metacarpophalangeal joint were 0 to 10 degrees and 0 to 25 degrees, respectively. He was able to oppose his thumb to all 4 digits. Six months after repair, he demonstrated protective sensation of the tip of the thumb.
Composite grafting of the thumb, even in less than ideal cases, can still provide useful length for function as a opposable post and can be considered in reconstruction of thumb amputations at or proximal to the lunula.
我们报告一例病例，其中拇指在甲半月近端的撕脱性截肢通过将截肢段作为复合组织移植重新附着进行修复。移植组织完全存活，长度仅有极小损失。
一名23岁男性在拇指撕脱伤合并远节和近节指骨骨折4小时后就诊。截肢段包括无菌和生发基质。他接受了截肢段的去脂和复合组织移植，随后对其近节指骨骨折进行克氏针固定。
在1周的随访中，患者的复合组织移植（包括甲床）完全存活。1个月时，复合组织移植保持稳定的软组织覆盖，并有甲板再生迹象。修复后4个月，他能够恢复轻体力工作，并在5个月内恢复全职工作。他持续报告移植边缘的感觉过敏逐渐改善以及指间关节僵硬。5个月时，他恢复了腕掌关节的完全活动度。他的指间关节和掌指关节活动范围分别为0至10度和0至25度。他能够将拇指与所有4个手指对掌。修复后6个月，他拇指尖有保护性感觉。
拇指复合组织移植，即使在不太理想的情况下，仍可为作为对掌指提供有用的功能长度，可考虑用于甲半月处或近端拇指截肢的重建。
