Roger de Oña Ignacio, Garcia Villanueva Andrea, Studer de Oya Alexis
Microsurgery Unit, Fremap Hospital, Madrid, Spain.
Microsurgery Unit, Fremap Hospital, Madrid, Spain.
J Hand Surg Am. 2018 Oct;43(10):955.e1-955.e9. doi: 10.1016/j.jhsa.2018.03.022. Epub 2018 Apr 25.
Thumb amputation at the carpometacarpal level is very incapacitating. Pollicization may be considered. We describe an alternate technique for thumb reconstruction at the level of the metacarpal base using a trimmed great toe along with a vascularized second metatarsophalangeal joint, including the second metatarsal, all supplied on a single vascular pedicle. Two patients who had a combined soft tissue defect and amputation of the thumb close to the carpometacarpal joint were reconstructed with this method. A transposition of the second toe was performed on top of the remaining proximal phalanx of the great toe to decrease donor site morbidity. This technique provides adequate length to the thumb without compromising another finger by creating a new thumb using a double microsurgical toe transfer on a single vascular pedicle. We minimize donor site morbidity by transposing the second toe onto the great toe.
掌指关节水平的拇指截肢会导致严重功能障碍。可考虑进行拇指再造术。我们描述了一种在掌骨基部水平进行拇指重建的替代技术，使用修剪后的拇趾以及带血管蒂的第二跖趾关节，包括第二跖骨，所有这些都由单一血管蒂供血。两名合并软组织缺损且拇指在掌指关节附近截肢的患者采用此方法进行了重建。将第二趾移位至剩余拇趾近节指骨上方，以降低供区并发症。该技术通过在单一血管蒂上进行双显微外科趾移植来创建新拇指，从而为拇指提供足够长度，同时不影响其他手指。我们通过将第二趾移位至拇趾来尽量减少供区并发症。
