Unit of Reconstructive Surgery of the Limbs, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
Microsurgery. 2023 Nov;43(8):837-841. doi: 10.1002/micr.31113. Epub 2023 Sep 15.
Reconstruction of osseous defects of the distal phalanx of the thumb is usually addressed with free bone grafts or free vascularized bone flaps. Some reports demonstrated the possibility to harvest an osteo-cutaneous flap in the dorso-ulnar side of the first metacarpal bone with success. In the same manner, no reports are present in the literature in which bone deficits were reconstructed with this flap elevated as an exclusively osseous flap. We report our successful experience with one case of distal phalanx reconstruction of the thumb by mean of the dorso-ulnar reverse flow pedicled osseous flap. The patient was a 45-year-old woman with symptoms related to a cystic bone tumor that involved the entirety of the distal phalanx of the thumb. Flap dimensions were calculated based on x-ray gap measures, which resulted in need of 1.5 × 0.8 × 0.5 cm flap dimensions. An osseous flap was harvested and transposed from the ulnar side of the first metacarpal bone. K-wire fixation was utilized for bone flap stabilization. No complications occurred and excellent functional result was evaluated at 6 months follow-up. In our opinion, the flap may be considered as an alternative to free bone grafts in situations in which perilesional tissues may jeopardize the process of free graft taking and in cases in which free vascularized bone flaps are not feasible for patient or surgeon decision.
拇指末节骨缺损的重建通常采用游离骨移植或游离带血管骨瓣。一些报道成功地展示了从第一掌骨的背侧-尺侧切取骨-皮瓣的可能性。同样，也没有文献报道过使用这种皮瓣作为单纯骨瓣来重建骨缺损。我们报告了一例成功的病例，通过背侧-尺侧逆行血流蒂骨瓣重建拇指末节。患者为 45 岁女性，有与累及拇指末节的囊性骨肿瘤相关的症状。根据 X 线间隙测量来计算皮瓣尺寸，结果需要 1.5×0.8×0.5cm 的皮瓣尺寸。从第一掌骨的尺侧切取骨瓣并转移。使用克氏针固定骨瓣以稳定。无并发症发生，6 个月随访时评估功能结果良好。我们认为，在以下情况下，该皮瓣可作为游离骨移植的替代方案：病变周围组织可能危及游离移植的过程，或者由于患者或术者的决策，游离带血管骨瓣不可行。
