Sinaga Bontor Daniel, Budi Dwi Purnomo Setyo, Sadabaskara Mochamad
Faculty of Medicine, Duta Wacana Christian University, Yogyakarta, Indonesia.
Department of Orthopedic and Traumatology, MRCCC Siloam Hospitals Semanggi, Jakarta, Indonesia.
J Trauma Inj. 2025 Mar;38(1):56-60. doi: 10.20408/jti.2024.0049. Epub 2024 Nov 18.
Thumb traumatic injuries are incredibly common in hand injuries. The thumb is essential to hand function in order to do daily tasks like gripping, holding, opposing, circumducting, and movements. As a result, compared to injuries to other fingers, a thumb injury significantly impairs hand function. Traumas can cause soft tissue loss linked to vascular injuries that require revascularization. Replantation is the surgical treatment most frequently suggested to patients who have had their thumbs amputated in an attempt to restore function and attractiveness. There are alternative reconstructive techniques, such as skin grafting or local, distal, and free flaps, when replantation of the severed segment is not feasible. Reconstruction techniques vary depending on where the amputation occurred and include transfer site reconstruction and homodigital and heterodigital flaps. We reported a case of a woman who has a right traumatic thumb injury due to blender accident. Primary suturing and debridement were done to save the thumb. But after several days, the thumb was necrotic and not viable. Heterodigital island flap from the right middle finger was chosen. Radial forearm skin was grafted to cover the middle finger defect. This gave satisfactory results. Wound healing was quite good, but there were signs of scar tissue growth after several months of follow-up. The function and mobility of the thumb and hand were also achieved well through the QuickDASH (quick Disability of the Arm, Shoulder and Hand) score. Heterodigital flap provides satisfactory results both aesthetically and functionally in traumatic thumb injury cases.
拇指创伤性损伤在手部损伤中极为常见。拇指对于手部功能至关重要，以便进行诸如抓握、握持、对掌、环转及各种动作等日常任务。因此，与其他手指损伤相比，拇指损伤会显著损害手部功能。创伤可导致与血管损伤相关的软组织缺失，而这需要进行血管重建。对于拇指被截断的患者，再植是最常建议的手术治疗方法，旨在恢复功能和外观。当无法进行离断节段的再植时，还有其他重建技术可供选择，如植皮或局部、远端及游离皮瓣。重建技术因截肢部位而异，包括转移部位重建以及同指和异指皮瓣。我们报告了一例因搅拌机事故导致右手拇指创伤性损伤的女性病例。进行了一期缝合和清创以挽救拇指。但几天后，拇指坏死无法存活。选择了取自右中指的异指岛状皮瓣。取桡侧前臂皮肤移植以覆盖中指缺损。结果令人满意。伤口愈合良好，但随访数月后有瘢痕组织生长迹象。通过手臂、肩部和手部快速残疾评定量表（QuickDASH）评分，拇指及手部的功能和活动度也恢复良好。在创伤性拇指损伤病例中，异指皮瓣在美学和功能方面均提供了令人满意的结果。
