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吻合皮神經的拇指尺背側動脈蒂逆行島狀皮瓣修復拇指軟組織缺損

IMPROVEMENT AND APPLICATION OF RETROGRADE ISLAND SKIN FLAP WITH AR TERIA POLLICIS DORSALIS IN ITS PEDICLE

Since 1992, the retrograde island skin flap with its pedicle containing the arteria pollicis dorsalis was used to repair 6 cases of the fingertip defects and the results were successful. The skin measured from 1.5cm x 2cm to 4cm x 3.5cm. From the followup, the external appearance of the thumbs looked nice, no limitation of joint motions was noticed and the pain sensation was recovered. The major improvement of this operation was that the donor skin was chosen from the dorsum of the first and second metacarpal bones, thus it was not necessary to divide the tendon of the extensor pollicis brevis, so that the operative procedure was simple and the postoperative functional recovery was rapid.

皮神經營養血管皮瓣的臨床運用

目的 探討吻合神經的手背皮神經營養血管皮瓣的臨床應用療效。 方法 2003年1月~2006年3月，采用拇指橈側、尺側、虎口背側支皮神經營養逆行島狀皮瓣修復拇指末節創面39例。男28例，女11例；年齡16～53歲。沖壓傷11例，電鋸傷23例，切割傷5例。皮瓣切取范圍3.3 cm×2.6 cm～5.6 cm×3.5 cm。術后予石膏制動、抗凝、解痙、預防感染等處理，2周后拆石膏行功能鍛煉。 結果 術后患者獲隨訪6～12個月，平均9個月。根據趙書強手功能評定標準改進標準進行臨床療效評定，優31例（79.5%），皮瓣成活，兩點辨別覺4～7 mm，對掌、對指功能恢復正常；良7例（17.9%），皮瓣遠端皮膚邊緣性壞死，兩點辨別覺5～9 mm，對掌、對指功能恢復接近正常；差1例（2.6%），皮瓣壞死，改行腹股溝皮瓣修復。 結論 該皮瓣手術切取成活率較高，術后外觀及功能恢復優良，是修復拇指末節創面的一種有效方法。

THUMB RECONSTRUCTION WITH SKIN AND SOFT TISSUE EXPANSION

Objective To evaluate a new reconstruction method for grades Ⅴ and Ⅵ defect with flap by skin soft tissue expansion technique. Methods From May 1998to September 2003, 8 cases of serious thumb defect were treated, including 6 males and 2 females, aging 18-27 years. The defect was caused by crush injury ofmachine in 6 cases and hot crush injury in 2 cases( 5 cases of grade Ⅴ and 3 cases of grade Ⅵ). The expander was placed under the tenor skin and softtissue.And then normal saline was infused to expand the skin and soft tissue graduallytill it was available for thumb reconstruction. Iliac autograft was fixed to residual thumb stump and covered with flap produce by expanded skin and soft-tissue.Postoperative rehabilitation was carried out. Results Allreconstructed thumbs were alive. After3-24 months follow-up, all reconstructed thumbs were with good sensation, appearance and durable. Twopoint discrimination was less than 5 mm. The functions of opposition, extend, abduction and endoduction were better in grade Ⅴ thumb defect than in grade Ⅵ thumb defect. Bone union was achieved within 3 to 4 months. Conclusion It is a convenient-to-operate and reliablemethod for thumb reconstruction. It is an alternative new reconstruction methodfor grades Ⅴ and Ⅵ thumb defect.

THUMB AND FINGER RECONSTRUCTION WITH THE PEDAL DIGIT TRANSPLANTATION: 541 CASES REPORT

Thumb and finger reconstruction by the method of pedal digit transplantation had been successfully performed in 541 casee from 1977 to 1996, which contained 404 cases of thumbs and 78 cases of fingers. The thumb reconstruction was mainly the simple transplantation of distal phalanx (42 cases) and the compound transplantation of hallucal nail-cutaneous flap with iliac bone segment (16 cases) for the defect of thumbs in degree 1 and 2. The combined transplantation of hallucal nail-cutaneous flap with the joint and tendons of the second toe (34 cases) and the transplantation of the distal part of the second toe (182 cases) for the defect of degree 3 and 4. The combined transplantation of the second pedal digit with its metatarsalphalangeal joint (189 caese) for the defect in degree 5 and 6. The finger reconstruction was performed by anastomosis of the arteries of the digit with those of the fingers for 29 cases with the defect in degree 2 and 3, 60 cases with the defect in degree 4 and 5, and 17 cases with the defect in degree 6. One-hundred and four cases of versels vasiation were found in this group (19 cases with the pedal dorsal artery, 13 cases with the greater saphenous vein and 72 cases with the first dorsal metatarsal artery). The main point of the operation and the treatment of the vessel variations were discussed.

股前外側穿支皮瓣修復甲瓣再造拇指足供區皮膚缺損

目的總結股前外側穿支皮瓣修復甲瓣再造拇指足供區皮膚缺損的臨床療效。 方法2010年10月－2012年12月，應用游離甲瓣移植再造拇指缺損10例。其中男7例，女3例；年齡17～45歲，平均26歲。拇指缺損程度按顧玉東分類法：Ⅰ度4例，Ⅱ度3例，Ⅲ度3例。受傷至手術時間2～11d，平均5d。趾供區均采用股前外側穿支皮瓣修復。 結果10例均獲隨訪，隨訪時間3～18個月，平均8個月。再造拇指及供區皮瓣全部成活，創面均Ⅰ期愈合。再造拇指外觀及掌指關節伸屈活動、拇指對指捏力恢復良好；均恢復了保護性觸痛覺，兩點辨別覺為10～15mm，平均12mm。足供區趾體外形良好，供趾的屈伸活動無明顯影響。隨訪6個月以上患者步態恢復正常，足部不適感及雙側變異基本消失，奔跑、彈跳基本不受影響。 結論甲瓣移植再造拇指聯合股前外側穿支皮瓣修復是供區缺損的手術方法既能完美再造拇指，又能很好地保留供趾功能。

REPAIR OF SEVERE NAIL BED DEFECTS WITH RADIAL DORSAL FASCIOCUTANEOUS FLAP OF THUMB

Objective To summarize the effectiveness of radial dorsal fasciocutaneous flap of thumb for repairing severe nail bed defects. Methods Between May 2009 and January 2012, 16 patients with severe nail bed defect were treated with radial dorsal fasciocutaneous flap of the thumb. There were 10 males and 6 females, aged 16-54 years (mean, 36 years). The causes of injury included crush injury in 10 cases, chainsaw injury in 4 cases, and scald in 2 cases; injured fingers were thumb in 3 cases, index finger in 4 cases, middle finger in 5 cases, ring finger in 3 cases, and little finger in 1 case. The time between injury and operation was 2 hours to 8 days (mean, 19.3 hours). Of 16 patients, 9 complicated by distal phalanx fracture. The area of defect ranged from 0.9 cm × 0.6 cm to 2.3 cm × 2.1 cm. According to ZHOU Qingwen’s grading system for nail bed defects, 6 cases were rated as degree III and 10 cases as degree IV. The area of flap ranged from 1.0 cm × 0.6 cm to 2.5 cm × 2.2 cm. Retrograde transposition was performed to repair the thumb defect, and pedicled transposition to repair the 2nd-5th fingers defects. The donor sites were directly sutured or were repaired with skin graft. Results All flaps and skin grafts survived, and wounds healed by first intention. All patients were followed up 6-12 months (mean, 8 months). The color, texture, and contour of the flaps were good. According to total active motion standard, the finger function was assessed as excellent in 10 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 87.5%. Conclusion Radial dorsal fasciocutaneous flap of thumb is a reliable flap with easy dissection and less trauma in repair of severe nail bed defects.

帶線錨釘重建韌帶治療陳舊性拇指腕掌關節半脫位

目的 總結帶線錨釘重建韌帶治療陳舊性拇指腕掌關節半脫位的療效。 方法 2015 年 10 月—2017 年 6 月，采用帶線錨釘重建韌帶治療 8 例陳舊性拇指腕掌關節半脫位患者。男 7 例，女 1 例；年齡 19～63 歲，平均 44 歲。致傷原因：機器撞擊損傷 4 例，運動損傷 3 例，交通事故傷 1 例。受傷至入院時間為 4～12 周，平均 8 周。拇、示指捏持無力，影像學檢查示拇指腕掌關節對合不全。 結果 術后切口均Ⅰ期愈合。8 例均獲隨訪，隨訪時間 9～24 個月，平均 18 個月。末次隨訪時，拇、示指捏持有力，X 線片復查示第 1 腕掌關節對合良好，無再脫位發生。根據中華醫學會手外科學分會手指關節總活動度系統評定方法評價療效，獲優 5 例、良 3 例，優良率 100%。 結論 帶線錨釘重建韌帶治療陳舊性拇指腕掌關節半脫位，手術操作簡便，療效良好。

Application of thumb blocking technique with ulnar Kirschner wire threading for Gartland type Ⅲ supracondylar humerus fractures in children

Objective To explore the effectiveness of thumb blocking technique through closed reduction of ulnar Kirschner wire threading in the treatment of Gartland type Ⅲ supracondylar humerus fractures in children. MethodsThe clinical data of 58 children with Gartland type Ⅲ supracondylar humerus fractures treated with closed reduction of ulnar Kirschner wire threading by thumb blocking technique between January 2020 and May 2021 were retrospectively analyzed. There were 31 males and 27 females with an average age of 6.4 years ranging from 2 to 14 years. The causes of injury were falling in 47 cases and sports injury in 11 cases. The time from injury to operation ranged from 24.4 to 70.6 hours, with an average of 49.6 hours. The twitch of ring and little fingers was observed during operation, the injury of ulnar nerve was observed after operation, and the healing time of fracture was recorded. At last follow-up, the effectiveness was evaluated by Flynn elbow score, and the complications were observed. Results There was no twitch of the ring and little fingers when the Kirschner wire was inserted on the ulnar side during operation, and the ulnar nerve was not injured. All children were followed up 6-24 months, with an average of 12.9 months. One child had postoperative infection in the operation area, local skin redness and swelling, and purulent secretion exudation at the eye of the Kirschner wire, which was improved after intravenous infusion and regular dressing change in the outpatient department, and the Kirschner wire was removed after the initial healing of the fracture; 2 children had irritation at the end of the Kirchner wire, and recovered after oral antibiotics and dressing change in the outpatient department. There was no serious complication such as nonunion and malunion, and the fracture healing time ranged from 4 to 6 weeks, with an average of 4.2 weeks. At last follow-up, the effectiveness was evaluated by Flynn elbow score, which was excellent in 52 cases, good in 4 cases, and fair in 2 cases, and the excellent and good rate was 96.6%. ConclusionThe treatment of Gartland type Ⅲ supracondylar humerus fractures in children by closed reduction and ulnar Kirschner wire fixation assisted with thumb blocking technique is safe and stable, and will not cause iatrogenic ulnar nerve injury.

橈側皮神經營養血管蒂逆行島狀皮瓣修復拇指末節皮膚缺損

目的 總結橈側皮神經營養血管蒂逆行島狀皮瓣修復拇指末節皮膚缺損的手術方法及臨床效果。 方法 2003 年1 月－ 2007 年1 月，收治16 例拇指末節皮膚軟組織缺損患者。男10 例，女6 例；年齡19 ～ 56 歲。電鋸傷6 例，壓砸傷5 例，切割傷4 例，電擊傷1 例。缺損范圍為2.0 cm × 1.5 cm ～ 3.5 cm × 3.0 cm。受傷至手術時間為4 h ～ 7 d。術中采用2 cm × 2 cm ～ 4 cm × 3 cm 橈側皮神經營養血管蒂逆行島狀皮瓣修復缺損。供區創面13 例直接縫合，3 例植皮修復。 結果 術后皮瓣及植皮均順利成活，供、受區切口均Ⅰ期愈合。12 例獲隨訪，隨訪時間6 個月～ 3 年。皮瓣質地、外形與周圍組織相似，血運、功能良好。拇指指間關節功能良好。 結論 采用橈側皮神經營養血管蒂逆行島狀皮瓣修復拇指末節皮膚缺損是一種簡便、有效的治療方法。