Shubinets Valeriy, Elliott River M
Department of Surgery, Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA.
OSS Health, York, PA.
J Hand Surg Am. 2018 Jan;43(1):89.e1-89.e7. doi: 10.1016/j.jhsa.2017.10.013. Epub 2017 Nov 11.
The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks. We describe an anterograde homodigital neurovascular island flap that provides both sensate and durable coverage of the ulnar thumb pulp. The flap uses innervated glabrous tissue, limits donor site morbidity to the thumb and first web space, and does not require microvascular anastomoses or nerve coaptation. The flap has been previously described for nonthumb fingertip injuries, but it has not been applied to the thumb. We discuss several important technical modifications that are essential to raising and insetting this flap in the thumb, review potential pitfalls, and highlight key steps to ensuring judicious intraoperative decision making and success.
拇指尺侧指腹是关键捏持和精细操作的重要组成部分。该区域损伤应以强健、有感觉的组织进行重建，以恢复体积和外形。然而，现有的重建方法存在重大风险和缺点。我们描述了一种顺行同指神经血管岛状皮瓣，它能为拇指尺侧指腹提供有感觉且持久的覆盖。该皮瓣使用有神经支配的无毛皮肤组织，将供区并发症局限于拇指和第一掌蹼间隙，且无需微血管吻合或神经吻合。此前该皮瓣已用于非拇指指尖损伤，但尚未应用于拇指。我们讨论了在拇指上掀起和植入该皮瓣所必需的几个重要技术改进，回顾了潜在陷阱，并强调了确保明智的术中决策和成功的关键步骤。
