Liu Hongjun, Regmi Subhash, He Yanyan, Hou Ruixing
Department of Hand and Foot Surgery, Rui Hua Hospital, Affiliated hospital of Suzhou University, 5 Tayun Road, Yuexi Town, Wuzhong District, Suzhou, 215104, Jiangsu, People's Republic of China.
Department of Hand and Foot surgery, Subei People's Hospital, Affiliated hospital of Yangzhou University, Yangzhou, Jiangsu, People's Republic of China.
Aesthetic Plast Surg. 2016 Oct;40(5):755-60. doi: 10.1007/s00266-016-0674-1. Epub 2016 Jun 29.
Thumb tip reconstruction has been a very challenging issue for hand surgeons. Varieties of reconstructive options have been described or modified to obtain satisfactory sensory recovery. However, none has yielded entirely satisfactory results. This study reports a retrospective review of clinical data records of patients treated with a neurovascular island pedicle flap obtained from the medial aspect of the long finger.
We enrolled 15 patients (9 men and 6 women), who received neurovascular island pedicle flaps for thumb tip amputations between December 2011 and December 2015. The average size of the flap was 2.8 × 2.2 cm(2) (range 2.5 × 1.8 cm(2) to 3.5 × 2.5 cm(2)). At the final follow-up visits, static two-point discrimination, visual analogue scale, Michigan hand outcome questionnaire and return-to-work time were used to evaluate surgical outcomes.
All flaps survived well. The follow-up period was 18 months. The mean static 2PD values at the reconstructed thumb tip and donor finger pulp (medial side) were 5.3 mm (range 4-8 mm) and 3.2 mm (range 3-4 mm), respectively. The average VAS scores for the aesthetic appearance of the donor site and recipient site were 9.1 (range 8-10) and 9.0 (range 8-9.5), respectively. The average Michigan Hand Outcome Questionnaire (MHOQ) score for hand function (reconstructed hand) was 8.2 (range 6-16). The average RTW time was 8.4 weeks (range 7-12 weeks).
Neurovascular island pedicle flap obtained from the medial aspect of long finger is a very reliable alternative technique for thumb tip defect reconstruction.
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拇指指尖重建一直是手外科医生面临的极具挑战性的问题。人们已经描述或改进了多种重建方法以获得满意的感觉恢复。然而，尚无一种方法能产生完全令人满意的结果。本研究报告了对采用取自示指内侧的神经血管岛状蒂皮瓣治疗的患者临床数据记录的回顾性分析。
我们纳入了15例患者（9例男性和6例女性），他们在2011年12月至2015年12月期间因拇指指尖离断而接受了神经血管岛状蒂皮瓣手术。皮瓣的平均大小为2.8×2.2平方厘米（范围为2.5×1.8平方厘米至3.5×2.5平方厘米）。在最后一次随访时，采用静态两点辨别觉、视觉模拟评分、密歇根手部结果问卷和重返工作时间来评估手术效果。
所有皮瓣均存活良好。随访期为18个月。重建拇指指尖和供区指腹（内侧）的平均静态两点辨别觉值分别为5.3毫米（范围为4 - 8毫米）和3.2毫米（范围为3 - 4毫米）。供区和受区美学外观的平均视觉模拟评分分别为9.1（范围为8 - 10）和9.0（范围为8 - 9.5）。手部功能（重建手）的平均密歇根手部结果问卷（MHOQ）评分为8.2（范围为6 - 16）。平均重返工作时间为8.4周（范围为7 - 12周）。
取自示指内侧的神经血管岛状蒂皮瓣是拇指指尖缺损重建的一种非常可靠的替代技术。
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