利用无再植条件的离断拇指骨骼肌腱移植一期再造拇指

Emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part without replantation condition

目的探讨利用软组织挫伤严重、无再植条件的离断拇指骨骼肌腱组织进行急诊再造拇指的可行性。方法将挫伤严重、无再植条件的离断拇指的皮肤和甲床剥除后,将骨骼、关节和肌腱组织原位回植,然后采用同侧游离■甲皮瓣移植再造拇指。结果 5例患者接受手术治疗,所有患者皮瓣均完全成活。随访4~18个月(平均10个月),再造拇指外观与健侧相似,两点辨别试验9.2~12.0 mm(平均10.1 mm)。保留的关节均有部分功能,5例患者掌指关节活动度为20°~90°(平均69.6°),2例患者指间关节活动度分别为15°和20°。所有患者均无感染和骨吸收发生。4例骨折顺利愈合,1例延迟愈合。结论软组织挫伤严重、无再植条件的离断拇指,如果骨骼肌腱保留完整,可用于拇指再造,并取得良好的临床效果。

Objective To investigate the feasibility of emergency thumb reconstruction for traumatic thumb amputation with bone and tendon from the amputated part,when the soft tissue is severely damaged and the amputated thumb is not replantable.Methods When the soft tissues of the amputated thumb was severely damaged and replantation was not applicable,thumb reconstruction as phase one emergency management was proceeded.The skin and nail bed of the amputated thumb was removed.The bone was in situ replanted,and the tendon was repaired.The nail flap from the ipsilateral toe was grafted and the bone and tendon was wrapped around to reconstruct the thumb.Results A total of 5 patients underwent surgical treatment.All reconstructed thumbs survived with an appearance similar to the contralateral sides.The patients were followed up for 10 months on average (range,4 to 18 months).The result of two-point discrimination test was10.1 mm on average (range,9.2-12.0 mm).The preserved joints possessed partial function.The average range of motion of the metacarpophalangeal joint was 69.6° (range,20° to 90°).The range of motion of interphalangeal joint was 15° and 20° in2 patients,respectively.No infection or bone resorption occurred.The injury was healed successfully in 4 patients,and delayed union occurred in one patient.Conclusion Complete bone and tendon from the nonreplantable amputated part combined with wrap-around flap can be used for emergency thumb reconstruction and it can achieve good clinical results.