示指拇化治疗重度拇指发育不全

目的 介绍示指拇化治疗先天性重度拇指发育不全(ⅢB～V型)的手术方法.方法 对Ⅳ型(漂浮拇)2例、ⅢB型(腕掌关节缺如)2例采用示指拇化,将示指自掌骨部位转位重建拇指.结果 4例移位指全部存活.术后随访2～3年,虎口开大70°～90°,接近健侧.拇指掌指关节屈曲后可与所有手指对指,近指间关节活动度从0°至100～120°,远指间关节活动度从0°至90°.指端两点分辨觉同健侧,外观和功能满意.结论 采用示指转位治疗重度发育不全的拇指,外形和功能满意,克服了以往采用皮瓣和骨瓣移植的缺点,是一种实用而可取的方法,值得推广.     

应用显微外科技术修复手大鱼际爆炸伤

应用显微外科技术修复手大鱼际爆炸伤陈智，沈翰手部大鱼际严重爆炸伤，可造成拇指主要血管、神经断裂，肌肉、肌腱等组织破坏，导致拇指坏死。本院自１９８９年３月起应用手掌血管弓转移吻合等方法，重建拇指血供，并一期修复其被破坏的组织效果满意。临床资料本组５例，...     

Austin截骨术治疗拇外翻

目的 探讨Austin手术治疗拇外翻的疗效.方法 自2000年至2005年,采用Austin手术方法治疗拇外翻患者89例169足.按常规治疗拇外翻的手术方法,松解拇趾跖外侧挛缩组织,显露跖骨头并切除内侧骨赘,跖骨内侧面"V"型截骨,截骨远端外移.结果 本组患者随访1～5年,优83例159足,良5例9足,可1例1足.术后无一例出现截骨延迟愈合及跖骨头缺血性坏死.结论 该手术方法操作简单,并发症少,疗效满意.     

Austin截骨术治疗拇外翻

目的探讨Austin手术治疗拇外翻的疗效。方法自2000年至2005年，采用Austin手术方法治疗拇外翻患者89例169足。按常规治疗拇外翻的手术方法，松解拇趾跖外侧挛缩组织，显露跖骨头并切除内侧骨赘，跖骨内侧面“V”型截骨，截骨远端外移。结果本组患者随访1～5年，优83例159足，良5例9足，可1例1足。术后无一例出现截骨延迟愈合及跖骨头缺血性坏死。结论该手术方法操作简单，并发症少，疗效满意。     

手部爆炸伤的临床分型与治疗

目的探讨手部爆炸伤新的临床分型以指导治疗、提高疗效。方法1997～2004年收治106例手部爆炸伤,按爆炸伤的严重程度和伤情特点将其划分四型：Ⅰ型：仅有皮肤灼伤、挫裂伤或手部的小面积皮肤缺损,治疗选用清创缝合或植皮修复;Ⅱ型：手部皮肤软组织缺损合并肌腱或骨关节损伤,但无手指血运障碍,治疗选用骨与关节复位固定、肌腱修复的同时必须采用皮瓣覆盖;Ⅲ型：手部广泛皮肤软组织缺损,伴有肌腱、血管、神经及骨关节损伤,手指缺血、离断或缺失,治疗必须应用显微外科技术实施血管吻合、断指再植或拇手指再造和皮瓣移植;Ⅳ型：手广泛毁损,治疗选择截肢术。结果本组Ⅰ型12例,手功能恢复正常;Ⅱ型31例,手功能恢复较好,14例遗留皮瓣臃肿或肌腱粘连,需二期治疗。Ⅲ型57例,无1例截肢,45例进行了二期功能重建手术,手功能恢复达正常的30%～80%不等;Ⅳ型6例,手功能完全丧失。结论该分型方法简明具体,便于临床判断受伤类型和选择治疗方法,并可估计愈合,对临床处理手部爆炸伤具有较好的指导意义。     

利用废弃指与股前外侧皮瓣串联急诊修复小儿手部鞭炮爆炸伤

目的 探讨小儿手部严重鞭炮炸伤急诊修复方法。方法 临床应用股前外侧皮瓣与废弃指串联急诊一期修复虎口和手部创面及再造拇指。结果 皮瓣及再造的拇指均顺利成活，经2年随访，手部外形及生长发育正常，再造拇指感觉均已恢复，两点辨别觉6mm-10mm，对掌对指功能良好。结论 在手部严重爆炸伤时应用股前外侧皮瓣与废弃指串联急诊一期修复虎口和手部创面及再造拇指，疗程短、疗效好。     

Austin截骨术联合拇内收肌切断手术治疗拇外翻

2007年4月～2010年12月,笔者采用Austin截骨术加联合拇内收肌切断手术治疗轻中度拇外翻15例21足,取得较满意疗效,报道如下。1材料与方法1.1病例资料本组15例(21足),均为女性,年龄35～58岁。病程5～16     

拇外展功能重建不同术式的比较

目的 通过对128例拇外展功能受损患的病例统计，列出常用手术方法，并通过比较得出不同方法的使用频率及结果优劣。方法按动力、伤因、神经损伤部位、神经损伤数及有无肌腱移植，进行列表统计，以找出规律。并强调了转移肌腱的方向应与拇短展肌轴线方向一致。结果术后经长期随访，环指屈指浅肌、掌长肌、尺侧伸腕肌等应用最多，平均优良率为87．2％，小指外展肌、屈拇短肌等例数较少，但效果很好，值得推广。结论各种伤因所致正中神经损伤及大鱼际肌损伤，均可导致拇指外展功能障碍，只要腕关节及腕掌关节被动活动良好，有良好的动力来源，就应考虑肌腱移位手术，修复拇指外展功能。     

Index finger pollicization

The thumb is a specialized organ with unique functions that cannot be replicated by any other digit. The most powerful technique for construction of a missing thumb is index finger pollicization. In this article, we outline our technique for index finger pollicization. Over a 30-year period, certain technical refinements have improved the function and appearance of these transposed digits.     

Pollicization of the index finger for radial hypoplasia

Background

Associated with anomalies such as VACTERL and Fanconi anemia, congenital hypoplasia of the thumb has a strong association with radial hypoplasia. The majority of patients have bilateral thumb underdevelopment, and those that have a unilateral deformity tend to have the right hand more commonly affected. In order to gain an opposable thumb, patients with a deficient carpometacarpal (CMC) joint, a floating thumb, or complete absence of the thumb can benefit with a thumb amputation and a translocation of the index finger (pollicization) to the thumb position. This video demonstrates the technical steps involved in performing a pollicization procedure in a patient with radial hypoplasia. The video is available electronically.

Methods

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all individual participants included in the video. The authors declare that they have no conflict of interest.

Results

Pollicization allows for improved functional results in patients with radial hypoplasia.

Conclusions

This video has reviewed the essential steps in performing a pollicization procedure in patients with radial hypoplasia.

Electronic supplementary material

The online version of this article (doi:10.1007/s11552-014-9693-z) contains supplementary material, which is available to authorized users.     

Index finger pollicization for congenitally deficient first finger of the hand in children

Pollicization is a single-stage neurovascular pedicle transfer of the index digit to function as a thumb. The objective of this study is to investigate the results of index finger pollicization for correction of congenital deficiency of the first ray in pediatric hand. We have done 6 pollicizations of index fingers in 6 hands (there were 2 right hands, 2 left hands, and 1 bilaterally) in 5 patients (4 boys and 1 girl) who had absent or nonfunctioning thumbs (type III-V of Blauth's classification). Associated anomalies where numerous and included radial club hand, mirror hand and cardiovascular and urologic anomalies. The average time of Kirschner wire extraction was 32 days (30 to 36 days) and to beginning the hand rehabilitation at 5 degrees to 10 degrees day. The average age at pollicization was 5.5 years (range 2 to 8 years), and follow-up averaged 8 years (5 to 11 years). The cosmetic and functional results were excellent, with manual dexterity of prehension and opposition. Pollicization in children can be performed at least 2 years of age, to due of minor risk of neurovascular lesion but without delayed the cortical representation of the pollicized finger.     

Combined index finger pollicization with an anterolateral thigh flap for thumb reconstruction

A severe crush injury to the hand is devastating to patients. Under conditions in which the crush force is too great, the digits are not viable candidates for replantation. We present two cases in which the patients suffered from loss of the thumb ray at the first carpometacarpal joint and skin defect at the radial side. The tendons, radial nerve and metacarpal bone of the index finger were injured, and the second metacarpal head was retained. There was a comminuted fracture of the trapezium in both patients. The treatment protocols consisted of the index finger pollicization and the free anterolateral thigh flap transfer. The procedure was performed in a single operation. The new thumb is able to provide a stable post for pinch and grip after six months follow-up. Both patients were satisfied with the function and appearance of the reconstructed thumb.     

Traumatized index finger pollicization for thumb reconstruction

PURPOSE: When the index finger is injured or severed in conjunction with a traumatic amputation of the thumb, transfer of the injured index finger can restore the important function of the thumb. The purpose of this study is to evaluate the results of the transfer of an injured index finger for traumatic loss of the thumb. METHODS: Seven patients treated by pedicled transfer of a traumatized index finger after amputation to the ipsilateral thumb were reviewed retrospectively. Postoperative evaluations included thumb range of motion, opposition and pinch function, grasp and pinch strength, sensation, a pick-up test, and a patient-rated appearance of the thumb and hand. Vascular patency of the traumatized index finger and thumb was evaluated in each patient prior to thumb reconstruction. RESULTS: After an average of 4 years of follow-up for surviving patients, all had excellent postoperative function and satisfactory results. The period between injury and thumb reconstruction ranged from 5 months to 4 years. All patients were men with a mean age of 43 years. Amputation levels included the metacarpophalangeal joint in 2 patients, the first metacarpal in 2 patients, and the proximal phalanx in 3 patients. All transferred traumatic index fingers survived without complications. CONCLUSIONS: Transfer of the injured index finger to the amputated thumb serves as an excellent adjunct for treatment of traumatic thumb amputations/crush injuries. Consistent results can be obtained while maintaining opposition and protective sensation after this procedure. However, technical demands are great, and initial injuries to the thumb and index finger ultimately determine the final outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

采用人工真皮修复大面积烧伤早期手部创面的疗效观察

目的:观察早期应用人工真皮修复大面积烧伤患者手部创面的效果.方法:选取2009年1月-2010年9月就诊于北京市右安门医院的大面积烧伤患者38例,采用随机分组方法分为两组.人工真皮组19例在早期修复手部创面手术中用人工真皮覆盖创面,2周后用自体刃厚皮片覆盖.对照组19例创面早期切痂、行自体微粒+异体皮移植,后期肉芽组织...     

手部感染创面的分类和治疗方法的选择

目的 根据手部创面的感染程度、波及组织的范围等，将手部感染创面分为3类并根据每类的特点选择最佳治疗方案。方法 对648例手外伤患者根据手部不同部位、不同组织、不同类型的感染创面，采用不同的组织移植术进行治疗。结果 648例手部感染创面一次手术治愈率为91．7％，需要再次手术治愈者54例，占5．3％。结论 手部各类不同程度的感染创面，在应用抗生素和彻底扩创术的基础上，采用显微外科技术进行各种组织移植术，只要方法选择得当，可以获得较高的一交手术治愈率。     

桡侧副动脉分叶穿支皮瓣修复手部不规则创面

[目的]分析桡侧副动脉分叶穿支皮瓣修复手部不规则创面的临床有效性和安全性.[方法]回顾性分析2017年7月-2019年6月本院收治的手部创伤性皮肤损伤106例患者的临床资料,其中,56例采用桡侧副动脉分叶穿支皮瓣修复(分叶组),50例采用常规桡侧副动脉穿支皮瓣修复(常规组).比较两组围手术期情况、随访期指标.[结果]两...     

Immediate pollicization of an amputated index finger

A case of immediate pollicization of an amputated index finger is reported. The patient sustained accidental amputation of the entire thumb and index finger and subtotal amputation of the middle finger of her left hand. Two years following replantation of the index finger to the thumb position, the finger has limited motion but the patient has a functional replanted digit.