Liu Yusha, Miller Erin A, Wee Corinne E, Prsic Adnan, Eble Danielle J, Kao Dennis S
the Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Wash.
Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Plast Reconstr Surg Glob Open. 2022 Jun 14;10(6):e4385. doi: 10.1097/GOX.0000000000004385. eCollection 2022 Jun.
Traumatic thumb amputation can have devastating effects on residual hand function. When replantation is not possible, thumb reconstruction is often performed in a delayed manner and may require multiple stages. Furthermore, reconstruction techniques often require microsurgical skills and equipment, which are not readily available at all institutions. This case series illustrates our technique for immediate osteoplastic thumb reconstruction following traumatic amputation.
This is a case series involving all patients who sustained unreplantable thumb amputations and underwent immediate osteoplastic thumb reconstruction with bone autograft and pedicled groin flap by the senior author from September 2016 through August 2018.
Five patients underwent immediate osteoplastic thumb reconstruction during the study period. Total operative time for the initial osteoplastic reconstruction averaged 158 minutes (range 96-290 minutes). In addition to flap division surgery, patients underwent an average of 1.2 revision procedures (range 0-2), primarily for debulking and hardware removal. Patients achieved an average gain in length of 3.3 cm compared with the maximum anticipated length with revision amputation at the time of injury, and had stable clinical outcomes for a minimum of 12 months.
Osteoplastic thumb reconstruction is a useful technique for thumb reconstruction for select patients following traumatic thumb amputation. Advantages of this approach include shorter overall operative times and hospital length of stay, minimal donor site morbidity, and a straightforward, reproducible technique.
创伤性拇指离断会对残留的手部功能产生毁灭性影响。当无法进行再植时，拇指重建通常会延迟进行，且可能需要多个阶段。此外，重建技术通常需要显微外科技术和设备，并非所有机构都能轻易获得。本病例系列展示了我们在创伤性拇指离断后立即进行骨成形性拇指重建的技术。
这是一个病例系列，纳入了2016年9月至2018年8月期间所有遭受无法再植的拇指离断并由资深作者采用自体骨移植和带蒂腹股沟皮瓣进行立即骨成形性拇指重建的患者。
在研究期间，5例患者接受了立即骨成形性拇指重建。初次骨成形性重建的总手术时间平均为158分钟（范围96 - 290分钟）。除了皮瓣断蒂手术外，患者平均接受了1.2次翻修手术（范围0 - 2次），主要用于减容和取出内固定物。与受伤时预计的最大截肢长度相比，患者拇指长度平均增加了3.3厘米，并且临床结果至少稳定12个月。
骨成形性拇指重建是创伤性拇指离断后部分患者进行拇指重建的一种有用技术。该方法的优点包括总体手术时间和住院时间较短、供区并发症最少以及技术简单、可重复。
