Department of Plastic and Reconstructive Surgery, Sohag University Hospital, Sohag, Egypt.
J Hand Surg Asian Pac Vol. 2022 Apr;27(2):313-319. doi: 10.1142/S2424835522500278. Epub 2022 Mar 31.
The aim of this study is to compare outcomes of reconstruction of palmar versus dorsal defects of the thumb using the first dorsal metacarpal artery (FDMA) flap with a cutaneous bridge segment. All FDMA flaps done at our centre for reconstruction of traumatic thumb defects in the period from November 2017 to May 2019 were included in this study. Data with regard to the patient, the injury and the flap were recorded. The outcome measures recorded include flap survival, complications, duration of follow-up, static two-point discrimination (2-PD), cortical reorientation, paresthesia at the flap and donor site, pain at the flap and donor site, Kapandji score and aesthetic outcome. The study included 11 patients with an average age of 35 years. All patients were men, and the injury involved the dominant thumb in seven patients. There were five dorsal defects and six palmar defects, and the average defect size was 7.22 sq cm. All flaps survived and there were no complications. The mean follow-up period was 15.2 months. The mean static 2-PD was 9.35 mm, cortical reorientation was complete in six patients, paresthesia score at the flap was 0.27 and at the donor site was 0.36. The visual analogue scale (VAS) pain for the flap was 1.09 and for the donor site was 1.27. The average Kapandji score was 8.64 and patients rated the aesthetic outcome of the flap at 8 and of the donor site at 7.36. There were no differences in outcomes between palmar and dorsal defects except for the aesthetic outcome of the flap that was rated better for dorsal defects. The FDMA flap designed with a cutaneous bridge segment provided reliable, single-stage reconstruction of dorsal and palmar thumb defects with good outcomes. Patients rated the aesthetic outcome of flaps used for dorsal reconstruction higher. Level IV (Therapeutic).
本研究旨在比较使用第一掌背动脉（FDMA）皮瓣加皮桥重建拇指掌侧和背侧缺损的结果。 本研究纳入了 2017 年 11 月至 2019 年 5 月期间在我们中心因创伤性拇指缺损而行 FDMA 皮瓣修复的所有患者。记录了患者、损伤和皮瓣的数据。记录的结果评估指标包括皮瓣存活率、并发症、随访时间、静态两点辨别觉（2-PD）、皮质重定向、皮瓣和供区感觉异常、皮瓣和供区疼痛、Kapandji 评分和美学结果。 本研究纳入了 11 例患者，平均年龄 35 岁。所有患者均为男性，7 例为优势拇指损伤。5 例为背侧缺损，6 例为掌侧缺损，平均缺损面积为 7.22 平方厘米。所有皮瓣均存活，无并发症。平均随访时间为 15.2 个月。平均静态 2-PD 为 9.35 毫米，6 例患者皮质重定向完全，皮瓣感觉异常评分为 0.27，供区为 0.36。皮瓣的视觉模拟评分（VAS）疼痛为 1.09，供区为 1.27。平均 Kapandji 评分为 8.64，患者对皮瓣和供区的美学效果评分分别为 8 分和 7.36 分。掌侧和背侧缺损的结果无差异，除了皮瓣的美学效果，背侧缺损的评分更好。 带皮桥的 FDMA 皮瓣可可靠地一期重建拇指掌侧和背侧缺损，效果良好。患者对用于背侧重建的皮瓣的美学效果评价更高。 四级（治疗）。
