Traumatized Index Finger Ray Pollicization Accompanied with Various Reconstructive Procedures for Post-traumatic Thumb Loss Proximal to Metacarpophalangeal Joint

受創食指使用拇指轉植術併用傳統及顯微手術重建比掌指骨指骨關節近心端之拇指缺損

林志鴻(Chih-Hung Lin) ； 林有德(Yu-Te Lin) ； 葉俊廷(Jiun-Ting Yeh) ； 陳建宗(Chien-Tzung Chen) ； 陳怡傑(Ji-Jeh Chen) ； 許聰政(Chung-Chen Hsu)

《中華民國整形外科醫學會雜誌》 15卷2期 (2006/06) Pp. 124-132

https://doi.org/10.7096/JPSA.200606.0124

摘要

近二十年來，隨著顯微手術的發展，腳趾移植手指已成為拇指缺損重建的主流，拇指轉植術已漸式微。但對於比掌指骨指骨關節近心端之拇指缺損，腳趾移植則不足以提供足夠的大拇指功能性長度。在大拇指嚴重壓碎性截肢時，鄰近的食指難免受創而功能或組織受損，於是可用來重建比掌指骨指骨關節近心端之拇指缺損，在此我們進行了七例拇指轉植術併用傳統及顯微手術重建比掌指骨指骨關節近心端之拇指缺損。傳統手術包括食指肌腱轉移，縮短，及對掌功能重建。顯微手術包括食指之指神經血管在吻合，及自由皮瓣重建虎口及軟組織缺損。其中一例失敗，然後就六例進行功能評估。
受創食指之拇指轉植術之知覺結果呈現兩點分辨能力是4-6mm，轉植之食指三個關節活動角度40-80度，拇指外展角是40-80度，迴轉角度是90-110度，對掌功能則是轉植之食指可觸及第四指尖至小指近位指關節。轉植之食指與第三指之側夾力量，和與第三四指之三點撮夾力量約為對側之20%。對於比掌指骨指骨關節近心端之拇指缺損，使用受創食指之拇指轉植術併用傳統及顯微手術重建可提供一可靠之治療結果。

並列摘要

Purpose: In the situation of thumb amputations proximal to metacarpophalangeal joints or extensive composite first ray defect, toe transfer may has the limitation of adequate functional length reconstruction Pollicization will be an alternative.
Materials and Methods: Seven patients underwent index finger pollicization for their thumb loss proximal to the metacarpophalangeal joint level. While three were reconstructed at chronic stage (7, 13, 15 months) after previous primary surgeries with inadequate basic hand functional restoration, four patient received pollicization at acute stage (within 1 week). Several tendon transfers including opponensplasty, intrincis tendon reconstruction were performed simultaneously. Four free flaps (3 anterolateral thigh flaps, 1 fibular flap) were transferred in acute reconstruction, and 2 local flaps and 1 groin flap in chronic stage reconstruction. Thee of four acute reconstruction require index finger revascularization during pollicization.
Results: One revascularized index ray failed and was lost. The other six patients achieved a basic hand functional reconstruction and have adequate opposition as Kapandji categories 5-8, abduction angle 58.3 degrees (40-80), and circumduction angle 103.3 degrees (90-110) to allow prehensile integration between the neo-thumb and 2-5th fingers. The tripod pinch was around 20% of the contralateral hand.
Conclusion: With the application of microsurgical technique and tendon transfers, pollicization using a traumatized and functional impaired index finger is a good alternative option for thumb loss proximal to MPJ, especially in the situation when toe-to-thumb transfer can not provide an adequate functional restoration.

並列關鍵字

Index finger pollicization ； thumb amputation