Segu Smitha Siram, Athavale Swapna Nachiket, Manjunath Peddi
Associate Professor and Unit head, Department of Plastic Surgery, BMCRI , Bangalore, India .
Post Graduate, Department of Plastic Surgery, BMCRI , Bangalore, India .
J Clin Diagn Res. 2015 Aug;9(8):PC11-3. doi: 10.7860/JCDR/2015/14334.6404. Epub 2015 Aug 1.
Loss of a thumb due to trauma warrants replantation which is the best method of reconstruction. When replantation is not possible, thumb reconstruction is the procedure of choice. The level of thumb amputation guides the type of reconstruction. There are five goals for reconstructing a thumb: restoration of (1) functional length (2) stability (3) mobility (especially opposition) (4) sensibility and (5) aesthetic appearance.
This study was conducted to evaluate the functional outcome of two main techniques of osteoplastic thumb reconstruction (1) Osteocutaneous distally based radial forearm flap (2) Groin flap with iliac crest bone graft.
Total 13 patients underwent osteoplastic reconstruction in the duration from August 2012 to December 2014. Thumb reconstruction was done using distally based radial forearm osteocutaneous flap in 7 patients and two staged reconstruction by groin flap with iliac crest bone graft in 6 patients. Postoperatively results were assessed in terms of range of motion, hand grip, functional recovery, donor site morbidity and patient satisfaction.
All reconstructive thumbs were functionally acceptable. Cosmetically, donor site morbidity was an issue for 2 patients with radial forearm flap and 1 patient with groin flap. Suture line dehiscence and plate exposure required intervention in local anaesthesia in one patient with radial forearm flap. After reconstruction absence of pain, temperature and touch sensation were observed.
We suggest that osteoplastic reconstruction is a reliable procedure in terms of stability, length, strength and opposability if basal joint is intact. Most of the patients in this study were manual labourers who went back to previous occupation and were able to use their thumb for daily activities for earning livelihood.
因创伤导致拇指缺失值得进行再植，这是最佳的重建方法。当无法进行再植时，拇指重建是首选手术。拇指截肢的水平指导着重建的类型。重建拇指有五个目标：恢复（1）功能长度（2）稳定性（3）活动度（尤其是对掌功能）（4）感觉功能和（5）美观外观。
本研究旨在评估两种主要的骨成形性拇指重建技术的功能结果：（1）远端蒂桡骨前臂骨皮瓣（2）带髂嵴骨移植的腹股沟皮瓣。
2012年8月至2014年12月期间，共有13例患者接受了骨成形性重建。7例患者采用远端蒂桡骨前臂骨皮瓣进行拇指重建，6例患者采用带髂嵴骨移植的腹股沟皮瓣进行两期重建。术后根据活动范围、握力、功能恢复、供区并发症和患者满意度进行评估。
所有重建的拇指在功能上均可接受。在美观方面，2例采用桡骨前臂皮瓣的患者和1例采用腹股沟皮瓣的患者存在供区并发症问题。1例采用桡骨前臂皮瓣的患者出现缝线裂开和钢板外露，需要在局部麻醉下进行干预。重建后未观察到疼痛、温度和触觉缺失。
我们认为，如果基底关节完整，骨成形性重建在稳定性、长度、力量和对掌功能方面是一种可靠的手术方法。本研究中的大多数患者是体力劳动者，他们恢复了以前的工作，并且能够使用拇指进行日常活动以维持生计。
