先天性Ⅵ型复拇指畸形的显微外科治疗

Microsurgical treatment of Wassel type VI thumb duplication

目的探讨儿童先天性Ⅵ型复拇指畸形的显微外科治疗方法。方法2009年3月至2012年7月共治疗6例先天性Ⅵ型复拇指畸形患儿，其中2例采用带赘生拇指血管神经蒂皮瓣移位矫形，4例采用带赘生拇指和血管神经蒂指体移位矫形主干拇指。重建拇内收肌止点。结果6例术后随访3个月至2年，5例外形获得明显改善，骨轴线正常，矫形拇指接近正常指，对指及外展功能正常。虎口开大距离5～7cm，移植后的皮瓣或矫形拇指感觉正常。1例皮瓣移植后的感觉及指间关节、掌指关节运动接近正常，但指间关节仍有80的尺偏位畸形。结论通过显微外科组合方法将主干拇指和赘生拇指合二为一，恢复矫形拇指和虎口的外形及功能。

Objective To evaluate the microsurgical procedures for treating Wassel type Ⅵ thumb duplication in children. Methods From March 2009 to July 2012, 6 cases of congenital Wassel type Ⅵ thumb duplication were treated. The skin-nail flap from the to-be-resected duplicate digit was transferred with its neurovascular pedicle to the remaining digit for reconstruction of the deformed thumb in 2 cases. In the other 4 cases, part of the to-be-resected duplicate digit along with its neurovascular pedicle was transferred to the preserved thumb. Insertion of the adductor pollicis was re-attached. Results The postoperative follow-up ranged from 3 to 24 months. Five cases showed marked improvement in appearance, normal thumb axis, near normal thumb contour, and recovery of normal opposition and thumb abduction. The width of the first web space was 5 to 7 cm. Normal sensation was restored in the transferred flaps or reconstructed thumbs. In one case, despite the normal sensation and joint movements, 8° of ulnar deviation in the interphalangeal joint was seen. Conclusion Combining the resected duplicate thumb with the preserved thumb using microsurgical technique can restore thumb and first web aunearance and function in cases of Wassel tvoe Ⅵ thumb duplication.