Chuang D C, Strauch R J, Wei F C
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Microsurgery. 1994;15(5):338-43. doi: 10.1002/micr.1920150510.
We report on two patients with severe injuries of the forearm who were reconstructed using functioning free muscle transplantation (FFMT) for individual replacement of flexor and extensor function. In both cases a two-stage procedure was performed: The extensor reconstruction preceded the flexor reconstruction by 4-6 months. The extensor digitorum communis and flexor digitorum profundus were successfully reconstructed in both cases using bilateral gracilis FFMT. In one case the flexor pollicis longus and extensor pollicis longus were also reconstructed using the adductor longus in addition to the gracilis. Clinical follow-up was a minimum of 2 years. Both patients achieved wrist control, excellent finger flexion, and metacarpophalangeal joint extension. One patient also had good interphalangeal finger extension, but the other developed a persistent claw deformity due to the lack of recovery of ulnar nerve function. Performing the extensor reconstruction prior to the flexor reconstruction theoretically allows a more rapid return of function and a shorter rehabilitation period than using the converse sequence.
我们报告了两名前臂严重损伤的患者，他们通过功能性游离肌肉移植（FFMT）进行了重建，以分别替代屈肌和伸肌功能。在这两个病例中，均采用了两阶段手术：伸肌重建比屈肌重建提前4至6个月进行。在这两个病例中，均使用双侧股薄肌FFMT成功重建了指总伸肌和指深屈肌。在一个病例中，除股薄肌外，还使用长收肌重建了拇长屈肌和拇长伸肌。临床随访时间至少为2年。两名患者均实现了腕关节控制、出色的手指屈曲以及掌指关节伸展。一名患者的指间关节伸展也良好，但另一名患者由于尺神经功能未恢复而出现了持续性爪形畸形。理论上，与采用相反顺序相比，先进行伸肌重建再进行屈肌重建可使功能恢复更快，康复期更短。
