Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2022 Dec;29(1):16-21. doi: 10.14744/tjtes.2022.58336.
It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options.
A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature.
The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was 'good' (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients.
Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.
确定最佳技术以实现令人满意的美学和功能结果来重建拇指缺损在临床上至关重要。我们旨在通过与其他当前的手术选择进行比较,定量展示第一掌背动脉皮瓣(FDMAF)的安全性、多功能性、局限性、优势和功能结果,并评估其在拇指缺损重建中的结果。
共有 21 名患者接受了拇指缺损重建。他们通过以下参数进行评估:病因、年龄、重建时机、皮瓣活力、Semmes-Weinstein 单丝(SWM)测试、静态两点辨别测试(2PD)、疼痛、皮质重定向、冷不耐受问卷和密歇根手功能问卷。通过与文献中其他当前的手术选择进行比较,评估他们的功能结果。
平均随访时间为 22.3 个月。皮瓣的平均疼痛评分为 0.4±0.6,且无患者在供区出现疼痛(范围 0-10)。根据静态 2PD 测试,感觉结果为“良好”(8.6 毫米)。平均 SWM 测试评分为 4.02g。根据密歇根手功能问卷,患者满意度为 4.6(范围 0-5)。冷不耐受问卷评分显示,患者有轻度冷不耐受(平均 10.5;范围 0-100)。81%的患者完全皮质重定向。
根据我们的结果,FDMAF 可实现拇指缺损的神经支配恢复,且患者满意度高。由于不存在显微血管或神经修复,手术更加简便,手术时间缩短,发病率降低,为更复杂的病例保留了显微外科选择。因此,可以得出结论,FDMAF 是一种有效的皮瓣,可对复杂的拇指缺损进行很好的改良,但外科医生在选择使用哪种技术时应考虑其临床结果和延长的手术时间。