Kang Ho-Jung, Sung Seung-Yong, Whang Jong-Ick, Hong Jung-Jun, Park Hyun-Sik, Kim Ji-Sup
Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Catholic-Kwandong University, 25, Simgok-Ro 100gil, Seo Gu, 22711 Incheon, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2020 Jan;73(1):65-71. doi: 10.1016/j.bjps.2019.07.002. Epub 2019 Aug 7.
The thenar flap is a well-described technique, but reports about its use in patients with multiple fingertip injuries are limited. This study aims to introduce a surgical technique of using an extended thenar flap for two adjacent fingertip amputations and to evaluate the clinical outcomes and related complications. From October 2013 to October 2016, 12 patients (24 fingers) underwent soft tissue reconstruction of two adjacent fingers with an extended thenar flap. At the last follow-up, the patients were assessed for cold intolerance in the reconstructed fingers; two-point discrimination (2PD); range of motion (ROM); functional outcomes using the quick disabilities of the arm, shoulder, and hand (DASH) score; functional and appearance outcomes using the Michigan Hand Outcome Questionnaire (MHQ); and time taken to return to work. The mean follow-up time was 13.5 (range: 12-16) months. All flaps survived. The mean total active ROM in flexion measured at the last follow-up was 255° (range: 245°-260°). Objective sensibility in the flaps was ascertained as an average static 2PD of 6.9 (range: 3-10) mm. The mean quick DASH score was 3.3 (range: 0-9.1). The mean MHQ score was 93.8 (range: 88-100). All patients returned to work within 6.2 weeks on average. There were no complications. The extended thenar flap technique is a good alternative for simultaneous coverage of small-to-large defects in two adjacent fingertips.
大鱼际皮瓣是一种已被充分描述的技术，但关于其在多指指尖损伤患者中的应用报道有限。本研究旨在介绍一种使用扩展大鱼际皮瓣修复相邻两指指尖离断的手术技术，并评估其临床疗效及相关并发症。2013年10月至2016年10月，12例患者（24指）采用扩展大鱼际皮瓣对相邻两指进行软组织重建。在末次随访时，评估重建手指的冷不耐受情况、两点辨别觉（2PD）、活动度（ROM）；采用手臂、肩部和手部快速功能障碍评分（DASH）评估功能结局；采用密歇根手功能结果问卷（MHQ）评估功能和外观结局；记录患者恢复工作的时间。平均随访时间为13.5（范围：12 - 16）个月。所有皮瓣均存活。末次随访时测得的平均总主动屈曲活动度为255°（范围：245° - 260°）。皮瓣的客观感觉功能确定为平均静态两点辨别觉为6.9（范围：3 - 10）mm。平均快速DASH评分为3.3（范围：0 - 9.1）。平均MHQ评分为93.8（范围：88 - 100）。所有患者平均在6.2周内恢复工作。无并发症发生。扩展大鱼际皮瓣技术是同时覆盖相邻两指从小至大缺损的良好选择。
