Melhuish Jake, Jervis Laetitia, Melhuish Kess X
General Physician, Royal Army Medical Corps, Oxford, GBR.
Paediatrics, University of East Anglia, Norwich, GBR.
Cureus. 2021 Jan 8;13(1):e12576. doi: 10.7759/cureus.12576.
The thumb is pivotal to many functions of the hand. Loss or absence of the thumb can be catastrophic to a patient's functioning. Different methods can be employed to surgically fashion a new thumb. This case report aims to demonstrate one patient's 34-year experience, reporting objective measures for a toe to thumb transfer, and documenting aesthetic outcomes. A semi-structured interview was conducted to gain insight into the patient's personal experiences. Validated assessment tools were used to assess range of movement and power, including Kapandji test, Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Cochin Hand Function Scale, Qingfeng Hand Dynamometer, Self-Administered Foot Evaluation Questionnaire (SAFE-Q). A physical examination on the neothumb was performed, along with photography to document aesthetic outcome. A 55-year-old white British male injured his right thumb whilst on a placement year in a sugar refinery in the Netherlands. The thumb was traumatically amputated proximal to the metacarpophalangeal joint. The patient lived for a year without a thumb on his dominant hand, which had a huge effect on his functioning, with extensive input from physiotherapists to help increase his handgrip strength. He then underwent a transfer operation, with the removal of the second toe which was transferred to create a right neothumb. The patient has high physical functioning of his neothumb, however, he is still mildly limited due to pain 34 years post-operation. The objective assessment tools demonstrate a high functioning of the neothumb, with only mild deficits in the dexterity and the physical functioning of the right hand. He experiences mild pain and reduced function of the donor foot. Light touch was found to be absent on the right thumb, but present on the left. Two-point discrimination was 7 mm on the right thumb, and 0.5 mm on the left. In this case, we present a toe to thumb transfer that had very good outcomes after 34 years with few complications. This case demonstrates that great adaptation can occur over long periods of time, restoring near-normal function. Measures of functional outcomes were generally high, with main deficiencies in fine motor skills such as picking up a penny from a flat surface and undoing small buttons. Additionally, there can be good long term outcomes from toe to thumb transfer despite moderate impairment of function. There is hope that this can be used to encourage and reassure patients and surgeons alike that the neothumb is likely to give good outcomes both functionally and aesthetically for many years.
拇指对于手部的许多功能至关重要。拇指的缺失或丧失对患者的功能可能是灾难性的。可以采用不同的方法通过手术塑造一个新的拇指。本病例报告旨在展示一名患者34年的经历，报告拇趾移植的客观测量指标，并记录美学效果。进行了一次半结构化访谈以深入了解患者的个人经历。使用经过验证的评估工具来评估活动范围和力量，包括卡潘迪试验、手臂、肩部和手部功能障碍（DASH）问卷、科钦手功能量表、清风握力计、足部自我评估问卷（SAFE-Q）。对再造拇指进行了体格检查，并拍照记录美学效果。一名55岁的英国白人男性在荷兰一家糖厂实习期间右手拇指受伤。拇指在掌指关节近端被外伤性截断。患者在优势手没有拇指的情况下生活了一年，这对他的功能产生了巨大影响，物理治疗师给予了大量帮助以增强他的握力。然后他接受了移植手术，切除了第二趾并将其移植以再造右手拇指。患者再造拇指的身体功能良好，然而，术后34年他仍因疼痛而有轻度功能受限。客观评估工具显示再造拇指功能良好，右手的灵活性和身体功能仅有轻度缺陷。他感到供足有轻度疼痛且功能下降。发现右手拇指触觉缺失，但左手存在。右手拇指两点辨别觉为7毫米，左手为0.5毫米。在本病例中，我们展示了一例拇趾移植，34年后效果良好且并发症很少。该病例表明，经过很长一段时间可以发生很好的适应性变化，恢复接近正常的功能。功能结果的测量指标总体较高，主要不足之处在于精细运动技能，如从平面上捡起一枚硬币和解开小纽扣。此外，尽管功能有中度损害，拇趾移植仍可取得良好的长期效果。希望这可以用来鼓励和让患者及外科医生放心，即再造拇指在功能和美学方面多年内可能都会有良好的效果。
