Nishijima N, Matsumoto T, Yamamuro T
Departent of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Japan.
J Hand Surg Am. 1995 May;20(3):415-9. doi: 10.1016/S0363-5023(05)80098-X.
A 2-year-old boy with grade 3 hypoplastic thumb (Blauth's classification) underwent reconstruction in two stages. Stage 1 was an abductor digiti quinti musculocutaneous flap, first web space widening, and insertion of a silicone rod to prepare for a flexor pollicis longus transfer. Stage 2 (6 months later) was a vascularized second toe proximal interphalangeal joint transfer for carpometacarpal joint replacement, plus tendon transfers for thumb flexion, extension, and adduction. Three years following the procedures, the thumb had an open physis by x-ray film and was functioning well. Pollicization is the traditional procedure for this degree of thumb hypoplasia, but the two-stage reconstruction is an alternative for patients in cultures where the presence of five fingers is important.
一名患有3级发育不全拇指（布劳思分类法）的2岁男孩分两期进行了重建手术。第一期采用小指展肌肌皮瓣、第一蹼间隙扩大以及插入硅胶棒，为拇长屈肌转移做准备。第二期（6个月后）采用带血管蒂的第二趾近侧指间关节转移来置换腕掌关节，同时进行肌腱转移以实现拇指的屈伸和内收功能。术后三年，X线片显示拇指骨骺开放，功能良好。对于这种程度的拇指发育不全，拇指再造术是传统术式，但对于一些文化背景下认为五指完整很重要的患者，两期重建手术是一种替代方案。
