皮肤软组织扩张术再造拇指

目的探讨采用皮肤软组织扩张术制作皮瓣，对拇指Ⅴ、Ⅵ度缺损实施再造的方法。方法1998年5月～2003年9月收治8例重度拇指缺损患者，男6例，女2例，年龄18～27岁。机器挫伤6例，热压伤2例。缺损部位均为掌骨中段及掌腕关节以远侧。其中Ⅴ度缺损5例，Ⅵ度缺损3例。于手掌桡侧置入扩张器，将局部皮肤软组织逐步扩张到足够再造拇指后，设计皮瓣；取自体髂骨游离移植、固定，皮瓣修复，完成再造。术后进行康复训练。结果再造拇指8例均成活。术后随访3～24个月，再造拇指感觉良好，两点辨别觉〈5mm。Ⅴ度缺损手功能对掌、伸、展、内收较好，Ⅵ度缺损功能恢复稍差。术后3～4个月骨性融合，皮瓣耐磨擦。结论皮肤软组织扩张再造拇指的方法操作简便，安全可靠，为重度拇指缺损（Ⅴ、Ⅵ度）提供了一种新的再造方法。

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 1998 to 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 of machine 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 soft-tissue. And then normal saline was infused to expand the skin and soft tissue gradually till 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: All reconstructed thumbs were alive. After 3-24 months follow-up, all reconstructed thumbs were with good sensation, appearance and durable. Two-point 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 reliable method for thumb reconstruction. It is an alternative new reconstruction method for grades V and VI, thumb defect.