背景:拇指多指畸形是最常见的先天性手畸形之一,通常使用Bilhaut-Cloquet程序或经过修改的程序。然而,争议仍然是罕见的情况下,在这两个拇指是不相似的长度或相距甚远。
目的:评价椎弓根复合组织瓣移植治疗不等拇指重复的临床效果。
方法:从2014年1月至2020年12月,15例患者在我们的手外科中心通过椎弓根复合组织瓣转移进行了重复拇指重建。当需要将长度不相似或相距遥远的切断和保存的拇指的不同组织结合起来时,使用该技术。获得主观父母的评估和功能结果(ALURRA和TATA标准)。对齐偏差,不稳定性,指间关节和掌指关节的活动范围(相对拇指的百分比),和美学方面,包括周长,长度,指甲大小,和指甲畸形,用于评估临床结果。
结果:手术时患者的平均年龄为13个月,平均最终随访发生在42个月。在14个重建的拇指中获得了合适的体积,关节稳定且外观良好。一个拇指出现不稳定的指间关节。掌指关节屈伸弧度良好,而指间关节的位置很差。大多数父母对重建拇指的外观和功能效果感到满意。平均ALURRA评分为21.8(范围:20-24),Tada得分为6.9(范围:5-8)。与非操作侧相比,手术拇指的长度约为95%,周长是89%,指甲宽度为82.9%。指间关节的平均运动范围为未受影响的拇指的62.1%,掌指关节的平均运动范围为78.3%。
结论:从切断的拇指收获带蒂皮瓣是一种安全可靠的方法。保存的拇指的缺陷,比如皮肤,钉,还有骨头,使用复杂的组织瓣可以有效地恢复。
BACKGROUND: Thumb polydactyly is one of the most common congenital hand deformities, and the Bilhaut-Cloquet procedure or a modified one is often used. However, controversy remains over the rare instances in which both thumbs are not of similar length or far apart in distance.
OBJECTIVE: To evaluate the clinical outcomes of pedicle complex tissue flap transfer in the treatment of duplicated thumbs with unequal size.
METHODS: From January 2014 to December 2020, 15 patients underwent duplicated thumb reconstruction by pedicle complex tissue flap transfer at our hand surgery center. The technique was used when it was necessary to combine different tissues from both severed and preserved thumbs that were not of similar length or far apart in distance. Subjective parents\' evaluations and functional outcomes (ALURRA and TATA criteria) were obtained. The alignment deviation, instability, range of motion (percent of opposite thumb) of the interphalangeal and metacarpophalangeal joints, and the aesthetic aspects, including circumference, length, nail size, and nail deformity, were used to assess the clinical outcomes.
RESULTS: The average age of patients at the time of surgery was 13 mo, and the mean final follow-up occurred at 42 mo. An appropriate volume with a stable joint and good appearance was obtained in 14 reconstructed thumbs. An unstable interphalangeal joint occurred in one thumb. The flexion-extension arc at the metacarpophalangeal joint was good, while that at the interphalangeal joint was poor. Most of the parents were satisfied with the cosmetic and functional results of the reconstructed thumbs. The mean ALURRA score was 21.8 (range: 20-24), and the Tada score was 6.9 (range: 5-8). Compared with the non-operated side, the length of the operated thumb was approximately 95%, the girth was 89%, and the nail width was 82.9%. The mean ranges of motion were 62.1% of that of the unaffected thumb in the interphalangeal joint and 78.3% in the metacarpophalangeal joint.
CONCLUSIONS: Harvesting a pedicle flap from a severed thumb is a safe and reliable procedure. Defects of the preserved thumb, such as the skin, nail, and bone, can be effectively restored using the complex tissue flap.