Sabapathy Shanmuganathan Raja, Venkatramani Hari, Bhardwaj Praveen, Mohan Monusha, Varadharajan Vigneshwaran
Department of Plastic, Hand, and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
J Hand Surg Glob Online. 2024 Nov 9;7(2):362-367. doi: 10.1016/j.jhsg.2024.10.003. eCollection 2025 Mar.
In severe mutilating injuries of the hand, microvascular toe transfers can help gain prehension. Radical debridement and primary wound healing, with or without a flap cover, are the prerequisites for a successful toe transfer. A pedicled groin flap is our preferred method of soft tissue cover. A primary toe transfer can be performed in cases of isolated thumb loss. The metacarpophalangeal joint should be preserved whenever possible. The first web space should be maintained to obtain optimal results. In cases where two toe transfers are required, the authors prefer to do them in two sittings; the thumb is reconstructed first, followed by finger reconstruction. A great toe is used for thumb reconstruction in patients where a part of the palm and multiple fingers are lost. Proper positioning of the thumb and high quality of tendon and nerve repair followed by adequate hand therapy will lead to ideal outcomes.
在手部严重毁损性损伤中，微血管趾移植有助于恢复抓握功能。彻底清创并实现一期伤口愈合，无论是否有皮瓣覆盖，都是成功进行趾移植的前提条件。带蒂腹股沟皮瓣是我们首选的软组织覆盖方法。对于单纯拇指缺失的病例可进行一期趾移植。应尽可能保留掌指关节。应维持第一掌骨间隙以获得最佳效果。在需要进行两次趾移植的情况下，作者倾向于分两次进行；先重建拇指，然后再重建手指。对于手掌部分及多个手指缺失的患者，使用拇趾进行拇指重建。拇指的正确定位、高质量的肌腱和神经修复以及充分的手部治疗将带来理想的效果。
