Rouanet M, Hu W, Letissier H, Seizeur R, Perruisseau-Carrier A
Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale-Blanche, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; Laboratoire d'anatomie de la faculté de médecine de Brest, UFR de médecine et de sciences de la santé, université de Bretagne Occidentale, 22, rue Camille-Desmoulins, 29200 Brest, France.
Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale-Blanche, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
Ann Chir Plast Esthet. 2022 Sep;67(4):211-223. doi: 10.1016/j.anplas.2022.05.003. Epub 2022 Jun 27.
The purpose of this study is to explore the feasibility of reconstructing the APB with a pedicled PQ flap, and to report results in a child presenting with bilateral radial deficiency.
Twenty-one injected cadaver upper extremities were dissected. The muscle was pedicled distally on the transverse carpal artery, and reinnervated with the flexor digiti minimi (FDM) motor branch. The transfer was evaluated on 3 parameters: surgical feasibility, length of the distal pedicle and distance from the coaptation site to the muscle entry of recipient nerve. A bilateral PQ pedicled transfer was accomplished in a 17-month old child with bilateral radial deficiency.
In the cadaver study, transfer of PQ to the APB was feasible and the distal end of the PQ transfer was reaching the radial side of the first metacarpophalangeal joint in all cases. The length of the distal pedicle on the transverse carpal artery was 38.5±0.20mm. The distance from coaptation of the FDM to the PQ muscle entry was 43.0±3.77mm. At 7 months, there was a cosmetic improvement of the thenar eminence, a bilateral M3 abduction of the thumb and a functional improvement from bilateral PQ pedicled transfer.
Reconstruction of the APB may be achieved with a PQ pedicled transfer reinnervated, improving the function and the cosmetic aspect of the thenar eminence without sacrificing any function of the hand.
本研究旨在探讨带蒂小指短屈肌（PQ）皮瓣重建拇短展肌（APB）的可行性，并报告1例双侧桡骨缺如患儿的治疗结果。
对21例上肢标本进行解剖。该肌肉以腕横动脉为远端蒂，并由小指短屈肌（FDM）运动支进行再神经化。从3个参数对该转移进行评估：手术可行性、远端蒂长度以及吻合部位到受区神经肌肉入口的距离。对1例17个月大的双侧桡骨缺如患儿实施双侧PQ带蒂转移。
在尸体研究中，PQ转移至APB是可行的，且在所有病例中，PQ转移的远端均能抵达第一掌指关节的桡侧。腕横动脉上远端蒂的长度为38.5±0.20mm。FDM与PQ肌肉入口的吻合距离为43.0±3.77mm。术后7个月，鱼际隆起外观改善，双侧拇指外展达M3级，双侧PQ带蒂转移后功能改善。
带蒂PQ转移再神经化可实现APB的重建，在不牺牲手部任何功能的情况下改善鱼际隆起的功能和外观。
