Tang Simon Fuk Tan, Tang Alice Chu Wen, Chen Chih Kuang, Wu Ho Mu, Wei Fu-Chan
From the Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
Lotung Poh-Ai Hospital, Lo-Hsu Medical Foundation, Yilan County, Taiwan.
Plast Reconstr Surg Glob Open. 2023 Sep 1;11(9):e5228. doi: 10.1097/GOX.0000000000005228. eCollection 2023 Sep.
Microsurgical great toe-to-thumb transfer (mGTT) is a widely used procedure when immediate replantation of thumb is not feasible. The aim of this study was to investigate the alteration of plantar pressure profile of the donor foot after mGTT.
Twenty patients receiving microsurgical great toe-to-hand transfer between 1985 to 2014, and 16 healthy subjects were recruited. Group 1 consisted of 20 feet receiving mGTT, whereas group 2 consisted of 32 normal feet as control. The flap design in this study was to preserve 1 cm of the proximal phalanx to maintain the attachment of the plantar aponeurosis and intrinsic muscles. The Taiwan Chinese version of the Foot Function Index was used for patient-reported outcome measurement. A novel Emed-X system was used for dynamic plantar pressure measurement. A total of four parameters were collected, including peak pressure, contact area, contact time, and pressure-time integral.
In group 1, the peak pressure redistributed under the first metatarsal bone and was significantly higher than group 2 ( < 0.05). There was no significant change of the contact area between the midfoot region of group 1 and group 2 ( > 0.05). Furthermore, similar foot clearance efficiency was demonstrated in group 1 and group 2 ( > 0.05).
The windlass effect of the foot will not be affected when performing mGTT with preservation of 1 cm of the proximal phalanx. Therefore, this surgical procedure is highly recommended for clinical application.
当拇指无法立即再植时，显微外科大脚趾至拇指转移术（mGTT）是一种广泛应用的手术。本研究的目的是调查mGTT术后供足足底压力分布的变化。
招募了1985年至2014年间接受显微外科大脚趾至手部转移术的20例患者以及16名健康受试者。第1组由接受mGTT的20只脚组成，而第2组由32只正常脚作为对照。本研究中的皮瓣设计是保留近端指骨1厘米以维持足底腱膜和固有肌的附着。采用台湾中文版足部功能指数进行患者报告结局测量。使用一种新型的Emed-X系统进行动态足底压力测量。总共收集了四个参数，包括峰值压力、接触面积、接触时间和压力-时间积分。
在第1组中，峰值压力在第一跖骨下方重新分布，且显著高于第2组（<0.05）。第1组和第2组中足区域之间的接触面积没有显著变化（>0.05）。此外，第1组和第2组表现出相似的足部离地效率（>0.05）。
在保留近端指骨1厘米进行mGTT时，足部的绞盘效应不会受到影响。因此，强烈推荐该手术方法用于临床应用。
