Song Fufang, Wang Wengang, Zhang Qingguo
Zhonghua Zheng Xing Wai Ke Za Zhi. 2015 May;31(3):191-4.
To investigate the reconstruction of thumb II-III degree defect by big toe wrap-around flap combined with second toe proximal interphalangeal joint.
Between May 2004 to July 2012, 25 cases with thumbs II-III degree defects were treated. The ipsilateral big toe wrap-around flap combined with second toe proximal interphalangeal joint was designed to reconstruct the thumb defects based on the thumb size on the healthy side. The distal end of hallux was covered by flap at tibial side. The wound at the fibula side was covered by skin graft and flap. The bone defect at the second toe was filled with remnant hallux or iliac bone.
All the 25 reconstructed thumbs survived completely. The patients were followed up for 6-26 months without any joint degeneration. According to the finger reconstruction functional criterion publicized by China Medical Association, the finger function was assessed as excellent in 10 case, good in 11 cases, poor in 4 cases. Joint necrosis happened in 2 cases and bone malunion in 2 cases. The 4 cases received dead bone debridement and iliac bone graft. No malfunction occurred in the donor site.
Our surgical method is a currently effective way to reconstruct II-III degree thumb defects. Satisfactory functional and cosmetic results can be achieved both in donor site and recipient site.
探讨采用吻合血管的第二趾近节趾骨间关节联合拇甲瓣移植再造Ⅱ～Ⅲ度拇指缺损的方法。
2004年5月至2012年7月，收治Ⅱ～Ⅲ度拇指缺损患者25例，根据健侧拇指大小设计患侧拇甲瓣联合第二趾近节趾骨间关节移植再造拇指，术中将拇趾胫侧皮瓣覆盖于再造拇指远端，腓侧创面植皮修复，第二趾骨缺损用残留拇趾或髂骨植骨修复。
25例再造拇指全部成活，随访6～26个月，关节无退变。按中华医学会手外科学会断指再植功能评定标准，优10例，良11例，差4例。2例发生关节坏死，2例骨不连，经死骨清除、髂骨植骨后愈合。供区无功能障碍。
吻合血管的第二趾近节趾骨间关节联合拇甲瓣移植再造Ⅱ～Ⅲ度拇指缺损是一种较好的手术方法，供、受区功能和外形满意。
