伴掌骨缺损的拇指再造

Reconstruction of Thumb Associated with Defect of Metacarpal Bone.

拇指缺损伴掌骨缺损共86例占拇指缺损病例33.6%。其中掌骨缺损40例,掌骨大部缺损28例,掌骨全缺如18例,应用足趾移植再造拇指成活82例占95.6%,应用趾半关节移植及跖趾关节移植再造掌指关节,术后随访前者平均活动度为26°,后者36°,但足底痛前者仅占8.7%,而后者占16.9%。应用手背局部转移皮瓣、足背皮瓣、皮管再造虎口,优良率分别为63.2%、87.1%及100%。但皮管法费时,手术次数多,体位不适,足背皮瓣切取后残留创面经常破溃。应根据掌骨缺损程度及虎口缺损情况选择相应手术方法。

86 cases of defect of thumb with defect of metacarpal bone were operated by the second toe transfer to reconstruction of the thumb, of which 82 cases were successful occuping 95. 6% of total cases. The metacarpal-phalangal arthral reconstruction of the thumb was completed by the hemi-arthral and full-arthral transplantation of metatarsal-phalangee joint of second toe. The results of follow-ups after operation revealed that the degree of movement of the joint was 26 in the former, 36% in the latter. The reconstruction of the first web by means of the local flap of the dasalis manual; dasalis pealical flap and groin flap. Fair results were obtainded with 63.2 %; 87. 1% and 100%. respectively. The disadvantages of groinflap method are timeconsuming, and incomfortable in position. The operative methods vary with the degree of the defect of the matacarpal bone and the condition of the web space