Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100144, China.
Chin Med J (Engl). 2019 Nov 5;132(21):2565-2571. doi: 10.1097/CM9.0000000000000477.
The predominant method for Manske type IIIB and IV thumb hypoplasia is pollicization. However, for those who are not willing to sacrifice the index finger, a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable. This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.
From May 2014 to January 2017, 15 patients with Manske type IIIB or IV thumb hypoplasia who were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital were included in this study. An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint. The donor site was reconstructed by a split half of the third metatarsal. Various functional reconstructions were commenced at second stage. The reconstructed thumbs were evaluated using the Kapandji score, pinch force, and the capacities of performing daily activities through a detailed questionnaire.
Among these 15 patients (seven type IIIB and eight type IV), there were ten boys and five girls with median age of 4.2 years (range: 2.0-7.0 years). There were seven right, three left, and five bilateral thumbs for whom only the right thumb received surgery. There were 14 metatarsal flaps survived (14/15). With an average follow-up of 19.2 months, the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function. All 15 children have improved the Kapandji score (from 0 to an average of 6.7), pinch force (from 0 to an average of 1.5 kg), with ability of grip and pen holding. X-ray indicated continuous bone growth. Patients and parents had good acceptance of the new thumb.
Reconstruction of an unstable hypoplastic thumb (Manske type IIIB and IV) with use of a vascularized metatarsal is an effective strategy. It offers an alternative solution for parents insisting on saving the thumb.
Manske ⅢB 型和Ⅳ型拇指发育不良的主要治疗方法是拇指再造术。然而，对于那些不愿意牺牲食指的患者，仍需要一种能够重建具有功能且外观可接受拇指的方法。本研究旨在探讨并评估应用带血管第二跖骨复合组织瓣进行拇指再造的功能和影像学结果，为提供一种新的选择。
自 2014 年 5 月至 2017 年 1 月，北京积水潭医院手外科共收治 15 例 Manske ⅢB 或Ⅳ型拇指发育不良患者。将包含第二跖骨及其远侧头部的骨皮瓣以逆行方式转移，重建近节-掌骨关节。供区采用第三跖骨的半劈开重建。二期开始进行各种功能重建。采用 Kapandji 评分、捏力和详细问卷调查评估重建拇指的日常活动能力。
15 例患者（7 例ⅢB 型，8 例Ⅳ型）中，男 10 例，女 5 例；年龄中位数为 4.2 岁（范围：2.0-7.0 岁）。右侧 7 例，左侧 3 例，双侧 5 例，仅右侧拇指接受手术。15 例患者中有 14 例（14/15）跖骨皮瓣存活。平均随访 19.2 个月后，重建拇指的功能和外观可接受，供足外观良好，无功能受损迹象。15 例患儿的 Kapandji 评分（由 0 提高至平均 6.7）、捏力（由 0 提高至平均 1.5kg）和握持、执笔能力均得到改善。X 线片显示骨持续生长。患者及其家长对新拇指的外观和功能均较满意。
应用带血管的跖骨重建不稳定的发育不良拇指（Manske ⅢB 型和Ⅳ型）是一种有效的方法，为坚持保留拇指的家长提供了另一种选择。
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