Khan Mansoor, Hayat Waqas, Khan Nasir, Ullah Hidayat, Ali Qazi, Khan Rashid
Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar.
Burns and Plastic Surgery Center, Hayatabad Medical Complex, Peshawar, Pakistan.
Pol Przegl Chir. 2022 Dec 20;95(4):0. doi: 10.5604/01.3001.0016.1601.
The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects.
This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (< 3 cm), medium (4-8cm) and large defects (> 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction.
After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects.
Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.
本文旨在分享我们基于拇指缺损情况（不论缺损病因）的经验，并致力于使拇指缺损的治疗标准化。
本研究于2018年至2021年在哈亚塔巴德医疗中心的烧伤与整形外科中心进行。拇指缺损分为小缺损（<3厘米）、中缺损（4 - 8厘米）和大缺损（>9厘米）。术后对患者的并发症进行评估。根据软组织缺损的大小和部位对皮瓣类型进行分层，以生成拇指软组织重建的标准化算法。
在仔细审查数据后，35名患者符合研究条件，其中男性占71.4%（25名），女性占28.6%（10名）。平均年龄为31.17 + 15.8标准差。研究人群中大多数患者的右手拇指受累（57.1%）。研究人群中大多数受机器损伤和创伤后挛缩影响，分别占25.7%（n = 9）和22.9%（n = 8）。第一掌骨间隙和拇指指间关节远侧损伤是最常受累的部位，各占28.6%（n = 10）。第一掌背动脉皮瓣是最常用的皮瓣，其次是逆行骨间后动脉皮瓣，分别在11例（31.4%）和6例（17.1%）中观察到。研究人群中观察到的最常见并发症是皮瓣充血（n = 2，5.7%），1例患者（2.9%）出现皮瓣完全坏死。根据皮瓣与缺损大小和位置的交叉列表分析结果，制定了一种算法，以帮助使拇指缺损的重建标准化。
拇指重建对于恢复患者的手部功能至关重要。对这些缺损采用结构化方法使其评估和重建变得容易，尤其对于新手外科医生。该算法可进一步扩展，以涵盖不论病因的手部缺损。这些缺损大多数可用易于操作的局部皮瓣覆盖，无需进行微血管重建。
