Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
BMC Surg. 2021 Jul 12;21(1):310. doi: 10.1186/s12893-021-01308-x.
Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication. We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji's score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm.
After successful reinnervation of all flaps, we found an improvement of Kapandji's score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed.
We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.
大鱼际肌或正中神经鱼际支损伤导致拇指对掌功能丧失，会严重影响手部功能。几十年来，重建方法一直基于肌腱转位。为了扩大重建方案，我们提出游离功能性旋前方肌皮瓣作为功能重建的可行替代方案，并提供其适应证的具体说明。我们通过单一切口重建，展示使用游离功能性旋前方肌皮瓣的手术技术。基于对三例患者的分析，使用 Kapandji 评分和 Bourrel 角、握力和神经传导速度进行了两年的随访，我们提出了一个适应证算法。
所有皮瓣均成功再神经支配后，Kapandji 评分从术前的 4.3±0.94 提高到两年后的 8.7±0.47。相应地，Bourrel 角从 75.75±3.45 度减少到 36.96±3.68 度。握力也从 14±2.2kg 增加到 26.2±1.2kg。未观察到手腕旋前功能受损。
我们发现拇指对掌和力量的功能恢复良好，与肌腱转位的结果相似甚至更优。由于单一切口手术的优势和最小的供区并发症，这种游离功能性肌肉转移是经典肌腱转位的可行替代方案。
