Ornelli Matteo, Ruocco Giovanni, Kaciulyte Juste, Lazzaro Lara, Felici Nicola
Azienda Ospedaliera San Camillo Forlanini, Unit of Reconstructive Surgery of the Limbs.
Santa Maria della Misericordia, Udine AOU, Plastic Surgery.
Handchir Mikrochir Plast Chir. 2019 Dec;51(6):434-439. doi: 10.1055/a-0874-2253. Epub 2019 Nov 7.
After loss of a thumb, the big toe is a possible donor site for reconstruction with wrap-around free flap and trimmed-toe transfer techniques. Early reconstructions seem to reduce the risk of post-operative infections, despite several studies that show different infection rates of the recipient site in immediate toe-to-hand transfer. The authors carried out a retrospective analysis of their experience in thumb reconstruction with big toe transfer and evaluated the results achieved with both immediate and delayed reconstructions in terms of infection occurrence.
From 2000 to 2017, patients who presented cut, crush and avulsion injuries in the thumb were selected and 33 toe-to-thumb transfers were performed. Patients were divided into two groups: in group A, patients underwent immediate reconstruction, while in group B delayed reconstructions were performed. The two groups received identical antimicrobial prophylaxis. Reliability of the immediate or delayed reconstruction was compared in terms of flap survival, requirement for a secondary intention healing and, in particular, rate of infection.
29 male and 4 female patients were treated. Toe-to-thumb transfers were performed in both groups: in group A, 8 wrap-around free flaps and 4 trimmed toe transfers; in group B, 11 wrap-around and 10 trimmed toe transfers. No flap loss occurred in either groups. No cases of infection were detected in the transferred toes.
For toe-to-thumb transfer, there are published reports of a wide range of infection rates of the recipient sites. The authors compared their results in terms of infection rate between immediate reconstruction, group A, and delayed reconstruction, group B. Immediate toe-to-thumb transfer showed equal success rates to delayed transfer. No statistically significant difference in risk of infection between the two groups was found. Results showed that the immediate reconstruction was as safe and reliable as the delayed one.
拇指缺失后，拇趾是采用吻合血管的游离皮瓣和截趾移植技术进行重建的可能供区。尽管有多项研究表明一期足趾移植到手后受区感染率不同，但早期重建似乎能降低术后感染风险。作者对其拇趾移植重建拇指的经验进行了回顾性分析，并从感染发生情况方面评估了一期和二期重建的效果。
选取2000年至2017年间拇指出现切割伤、挤压伤和撕脱伤的患者，共进行了33例足趾移植到拇指的手术。患者分为两组：A组患者接受一期重建，B组进行二期重建。两组接受相同的抗菌预防措施。从皮瓣存活情况、二期愈合需求，尤其是感染率方面比较一期或二期重建的可靠性。
共治疗29例男性和4例女性患者。两组均进行了足趾移植到拇指的手术：A组，8例吻合血管的游离皮瓣和4例截趾移植；B组，11例吻合血管的游离皮瓣和10例截趾移植。两组均未发生皮瓣丢失。移植的足趾未检测到感染病例。
关于足趾移植到拇指，有报道称受区感染率范围广泛。作者比较了一期重建（A组）和二期重建（B组）在感染率方面的结果。一期足趾移植到手的成功率与二期移植相同。两组之间在感染风险上未发现统计学显著差异。结果表明一期重建与二期重建一样安全可靠。
