Saha Srinjoy
Department of Plastic Surgery, Apollo Multispecialty Hospital, Kolkata, West Bengal, India.
J Orthop Case Rep. 2022 Dec;12(12):90-94. doi: 10.13107/jocr.2022.v12.i12.3478.
The human thumb is critical for performing complex movements with the hand. Injuries to the thumb can significantly impact an individual's livelihood, and those with exposed bones or tendons have traditionally been treated with terminalization or reconstructive flap surgeries. However, many patients feel that their results could be better.
We attempted a novel approach stacking multiple layers of a dermal regeneration template in a quest for better results. A young male teacher presented to our clinic with a 2-day-old severely injured thumb tip. Attempting to regenerate the lost fingertip, we first stacked the inner absorbable layers of the template layer-by-layer over the exposed bone and raw areas. Then, we injected platelet-rich fibrin (PRF) around the wound intraoperatively and at weekly intervals for a month to encourage soft-tissue development. After 6 months, we observed near-total soft-tissue development and good anatomical restoration of the lost thumb tip. Sensation returned to near-normal levels, with full functional recovery of the thumb and hand.
Our minimally invasive approach to reconstructing the distal thumb after an Allen Type 3 traumatic injury, utilizing PRF and a regenerative template, is a safe and effective alternative to traditional treatments. This innovative method has improved upon previously described results and may offer hope to many patients with severe thumb injuries.
人类拇指对于手部进行复杂动作至关重要。拇指受伤会严重影响个人的生活，而那些骨头或肌腱外露的患者传统上接受截指术或重建皮瓣手术治疗。然而，许多患者觉得治疗效果仍可改善。
我们尝试了一种新颖的方法，即堆叠多层真皮再生模板以寻求更好的效果。一名年轻男性教师因拇指尖严重受伤2天前来我们诊所就诊。为了再生缺失的指尖，我们首先将模板的可吸收内层逐层堆叠在暴露的骨头和创面区域上。然后，我们在术中及术后每周向伤口周围注射富血小板纤维蛋白（PRF），持续一个月以促进软组织生长。6个月后，我们观察到软组织几乎完全生长，缺失的拇指尖实现了良好的解剖学修复。感觉恢复到接近正常水平，拇指和手部功能完全恢复。
我们采用PRF和再生模板对艾伦3型创伤后拇指远端进行重建的微创方法，是传统治疗的一种安全有效的替代方案。这种创新方法改进了先前报道过的治疗效果，可能为许多严重拇指损伤患者带来希望。
