Buck-Gramcko D
Handchirurgie. 1981;13(1-2):14-27.
Reconstruction of the thumb following amputation injuries: In this review of the different methods of thumb reconstruction following traumatic amputation, the procedures applicable in the primary care of the hand are first mentioned and demonstrated: replantation of a thumb, cover of a distal amputation with a neurovascular flap and salvage of a thumb with intermediate segmental loss. In most instances the thumb reconstruction is performed as a secondary procedure. The indication and the selection of the method depend upon the level of amputation, the dominance of the injured hand, and the presence of other injuries to the same hand as well as age, sex, occupation, and intelligence of the patient. There are several different operative methods: 1) Deepening of the first web space (phalangisation of the first metacarpal) by means of a Z-plasty with proximal transposition of the insertion of the adductor pollicis muscle. 2) Lengthening of the first metacarpal with a bone graft either as Gillies cocked hat procedure or as interposition following distraction of the osteotomized two parts of the metacarpal in one stage or as continuous distraction (Matev). --Both methods are performed often in combination and are indicated in loss of the thumb at the base of the proximal phalanx or at the MP-joint in the non-dominant hand or in unskilled workmen. 3) Osteoplastic methods with bone graft, tube pedicle and neurovascular island flap have the risk of absorption of the bone graft and therefore more limited indications. These are given in unskilled manual workers with no other injured digits and in multiple loss of digits where toe transfer is not appropriate. 4) Transposition of another intact or partially amputated digit on a neurovascular pedicle. The two different operative techniques depend upon the presence or loss of the first metacarpal and the thenar muscles. The indication is given in amputations at any point proximal to the base of the proximal phalanx in either hand of most women, children and skilled workers. 5) Free toe transfer is indicated if there is not any other finger or part of a finger available and the first metacarpal is preserved. In exceptional cases a free transfer of a digit of the contralateral hand is possible.
在这篇关于创伤性离断后拇指重建不同方法的综述中，首先提及并展示了适用于手部初级护理的手术：拇指再植、用神经血管皮瓣覆盖远节离断伤以及挽救伴有中间节段缺失的拇指。在大多数情况下，拇指重建作为二期手术进行。手术指征和方法的选择取决于离断水平、伤手的优势、同一只手是否存在其他损伤以及患者的年龄、性别、职业和智力。有几种不同的手术方法：1）通过Z形皮瓣成形术并将拇收肌止点近端移位来加深第一掌骨间隙（第一掌骨指骨化）。2）用骨移植延长第一掌骨，可采用吉利斯“歪帽”手术，或在一期将截断的两部分掌骨牵开后进行骨间植入，或持续牵张（马特夫法）。——这两种方法常联合使用，适用于非优势手近端指骨基部或掌指关节处拇指缺失的情况，或从事非技术工作的工人。3）采用骨移植、管状蒂和神经血管岛状皮瓣的骨成形方法有骨移植吸收的风险，因此适应证更有限。适用于无其他手指损伤的非技术体力劳动者以及不适宜进行足趾移植的多指缺失情况。4）将另一个完整或部分离断的手指带神经血管蒂移位。两种不同的手术技术取决于第一掌骨和大鱼际肌的存在或缺失情况。适用于大多数女性、儿童和技术工人双手近端指骨基部近端任何部位的离断伤。5）如果没有其他可用手指或手指部分且第一掌骨保留，则可进行游离足趾移植。在特殊情况下，对侧手的手指游离移植也是可行的。
