拇指桡背侧筋膜蒂逆行岛状皮瓣修复拇指末节皮肤缺损

目的报道应用拇指桡背侧筋膜蒂逆行岛状皮瓣修复拇指末节皮肤缺损的临床疗效。方法根据拇指桡侧指背神经的解剖特点。采用带拇指桡侧指背神经及其营养血管的皮瓣修复拇指末节皮肤缺损。结果皮瓣全部成活,随访2～10个月,皮瓣质地柔软、耐磨,外观自然、不臃肿,指端饱满,两点辨别觉5-12mm,供区外观及功能无明显影响。结论拇指桡背侧筋膜蒂逆行岛状皮瓣是修复拇指末节皮肤缺损的较好方法。     

第一掌骨背逆行筋膜皮瓣修复拇指皮肤缺损

目的介绍一种修复拇指皮肤缺损的新型逆行筋膜皮瓣。方法取１０只新鲜尸体手，从桡动脉灌注红色乳胶，对第一掌骨背及拇指指背软组织的血管进行显微解剖，根据其血管分布设计成第一掌骨背逆行筋膜皮瓣。自甲根部桡侧缘至第一掌骨同侧背侧缘的连线为轴心线，其蒂部宜设在拇指指间关节近侧１ｃｍ以近的轴心线上。结果第一掌骨背及拇指指背软组织的血供主要由拇指两条指掌侧固有动脉向指背侧发出的分支，在指背筋膜内与两侧指背动脉及桡神经浅支伴行血管（桡、尺侧各２条）形成的血管网提供。１９９６年２月～１９９７年９月，临床应用该皮瓣修复拇指皮肤缺损６例，皮瓣全部成活。结论第一掌骨背及拇指指背软组织血供丰富，可形成第一掌骨背逆行筋膜皮瓣。该皮瓣设计合理、血供可靠、操作简便，适用于修复拇指，尤其是拇指桡侧皮肤的缺损     

急诊修复拇指指腹缺损三种方法的研究

目的 报道采用不同方法急诊修复拇指指腹缺损的疗效。方法 采用示指背侧岛状皮瓣，拇指桡侧指动脉逆行岛状皮瓣转位有趾腹皮瓣游离移植三种方法，为21例线指指腹缺损进行急诊修复。结果 20例以瓣成活，1例失败。术后随访半年－2年，平均10个月。所有皮瓣血运，弹性，质地均良好。指腹二点分辨觉：示指背侧岛状皮瓣平均为92.mm，拇指桡侧动脉逆行岛状皮瓣平均为8mm，趾腹皮瓣平均为5.6mm。结论 急诊修复拇指指腹缺损首选趾腹皮瓣，其次为拇指桡侧指动脉逆行岛状皮瓣或示指背侧岛状皮瓣。     

第一掌骨尺背侧逆行岛状筋膜皮瓣修复拇指末节偏尺侧缺损

目的：探讨以指动脉穿支为蒂的第一掌骨尺背侧带拇指尺背侧皮神经逆行岛状筋膜皮瓣修复拇指末节偏尺侧软组织缺损的手术方法及治疗效果。方法：对15例拇指末节偏尺侧缺损伴有骨外露患者行第一掌骨尺背侧逆行岛状筋膜皮瓣修复,以拇指尺背侧皮神经走行为轴线,以拇指近节尺侧中点为旋转点,拇指尺侧指固有动脉背侧穿支为蒂,于第一掌骨尺背侧切取皮瓣。结果：术后皮瓣全部成活,随访3。11个月,平均随访5．1个月,按中华医学会手外科学会上肢部分功能评定试用标准评定,优良率87％。结论：以指动脉穿支为蒂的第一掌骨尺背侧带拇指尺背侧皮神经筋膜岛状皮瓣修复拇指末节偏尺侧缺损,外观满意,功能良好。     

拇指桡侧逆行筋膜皮瓣修复拇指软组织缺损

目的介绍拇指桡侧逆行筋膜皮瓣修复拇指软组织缺损的手术方法。方法2004年4月至2007年5月,对21例患者用拇指桡侧逆行筋膜皮瓣,分别修复拇指腹、背侧及桡侧软组织缺损。皮瓣设计在拇指桡侧,以指侧正中线为轴线,其蒂部转折点在软组织缺损区近端0.5-1.0cm处,不能超过拇指指间关节。皮瓣面积最大4.0cm×3.0cm,最小2.0cm×1.5cm,吻合指神经17例。结果21例皮瓣全部成活,术后随访6-24个月,外形美观,质地柔软,吻合指神经的指腹两点分辨觉为6-8mm,其余为8-12mm。结论拇指桡侧逆行筋膜皮瓣具有操作简便、质地良好、血供可靠等优点,是修复拇指软组织缺损的较好方法。     

拇指桡侧逆行筋膜皮瓣修复拇指软组织缺损

目的　介绍拇指桡侧逆行筋膜皮瓣修复拇指软组织缺损的手术方法。方法　 1998年 8月至 1999年 12月 ,对 7例患者用拇指桡侧逆行筋膜皮瓣 ,分别修复拇指指腹、背侧及拇桡侧软组织缺损。皮瓣设计在拇指桡侧 ,以指侧正中线为轴线 ,其蒂部转折点在软组织缺损区以近 0 .5cm～ 1.0cm处。皮瓣面积最大 4.3cm× 3 .0cm ,最小 2 .5cm× 1.5cm。结果　 7例的皮瓣全部成活 ,术后随访 5～ 8个月 ,外形美观 ,质地柔软 ,指腹二点分辨觉 (2 PD)为 7～ 12mm。结论　拇指桡侧逆行筋膜皮瓣具有操作简便、质地良好、血供可靠等优点 ,是修复拇指软组织缺损的较好方法     

应用拇指桡侧皮神经逆行岛状皮瓣修复拇指末节皮肤缺损

目的观察应用拇指桡侧皮神经逆行岛状皮瓣修复拇指末节皮肤缺损的临床效果。方法皮瓣的旋转点为拇指指间关节以近任意点,轴心线为指间关节中点偏桡侧1.0 cm与掌指关节中点偏桡侧1.5 cm之连线,沿设计线切开,分离并切断拇指桡侧皮神经,拇指保留1.5 cm的筋膜蒂,明道旋转180,°转移至拇指末节皮肤缺损处。皮瓣切取的最大面积3 cm×4 cm,最小为2 cm×2 cm。结果术后16例16指皮瓣全部成活,随访6个月~3年,皮瓣质地、外形与周围组织相似,血运、功能良好,供区无明显并发症。结论拇指桡侧皮神经营养逆行岛状皮瓣是修复拇指末节皮肤软组织缺损较理想的方法 。     

拇指指腹缺损的显微外科修复

目的 探讨含感觉神经的微型皮瓣修复拇指指腹缺损的临床疗效.方法 2000年2月-2010年3月,采用食指背岛状皮瓣、中指侧方岛状皮瓣、以桡侧指动脉为蒂逆行岛状皮瓣、桡动脉掌浅支为蒂的逆行皮瓣、拇指尺背侧动脉逆行皮瓣、拇指背皮神经营养血管皮瓣、第2趾趾腹皮瓣、？？趾甲皮瓣、大鱼际部浅静脉动脉化逆行皮瓣共9种皮瓣修复重建拇指指腹缺损134例.结果 3例皮瓣坏死,131例成活,6个月～1.5年随访108例,皮瓣外形血供充分,质地柔软,感觉测定S2～S4＋,两点辫别觉6～11mm.结论 采用含感觉神经的微型皮瓣修复拇指指腹缺损,对供区影响小、效果佳、为理想的术式选择.     

拇指尺背侧动脉为蒂的逆行皮瓣的临床应用

目的总结以拇指尺背侧动脉为蒂逆行皮瓣的切取方法和临床应用经验。方法对13例拇指远端软组织缺损并伴骨外露者,采用以拇指尺背侧动脉为蒂的皮瓣逆行转移修复。该皮瓣的设计以拇指尺背侧动脉体表投影线为轴心线,距甲沟2.3 cm处纵轴线向背侧动脉穿支为旋转点。皮瓣面积可达3.5 cm×2.5 cm。结果 13例皮瓣全部成活。术后随访2~6个月,皮瓣质地良好,拇指外形满意,指腹二点分辨觉为6~10 mm。结论拇指尺侧指背动脉逆行岛状皮瓣操作简单、质地良好、血供可靠,可避免损伤指固有血管,是修复拇指软组织缺损的较好方法。     

拇指桡背侧动脉逆行岛状皮瓣修复拇指远节软组织缺损

目的评估拇指桡背侧动脉逆行岛状皮瓣修复拇指远节软组织缺损的临床疗效。方法自2012-05—2014-09采用拇指桡背侧动脉逆行岛状皮瓣修复拇指远节软组织缺损12例,9例远节指腹软组织缺损行皮瓣桡神经浅支、拇指指掌侧固有神经显微缝合术。结果本组2例皮瓣出现静脉回流障碍,蒂部拆线后缓解。1例皮瓣远端部分坏死,经换药创面愈合。其他皮瓣均完全成活。9例拇指指腹软组织缺损行神经缝合,3例拇指指背软组织缺损未行神经缝合。12例均获得随访6~12个月,皮瓣外观好,质地厚实、耐磨,修复指腹缺损的9例皮瓣两点辨别觉9~14 mm,平均10.6 mm。皮瓣供区10例直接缝合,2例行全厚皮片植皮术,均一期愈合。患者主观感觉均满意。结论拇指桡背侧动脉逆行岛状皮瓣是修复拇指远节软组织缺损的一种较好的皮瓣,具有血供可靠、外观好、供区损伤小、可缝合神经重建指腹感觉的优点。     

Flexion deformities of the thumb: clasped thumb and trigger thumb

Congenital clasped thumb in palm corresponds to a spectrum of anomalies leading to a loss of thumb extension and abduction. Intrinsic muscles and skin shortening are not infrequent. Conservative orthopedic treatment should be undergone as soon as possible. When this treatment fails, or when patients are seen late, surgical correction has to be customized according to the involved structures. The trigger thumb is 10 times more frequent than the trigger finger. It is bilateral in 30% of the cases. The term "congenital" remains unclear as several investigations on newborns have not evidenced trigger thumb. In children, it is very rare to find a real trigger and presentation consists in a fixed flexion deformity of the interphalangeal joint. Diagnosis is clinical, with a palpable nodule at the level of T1 pulley. Conservative treatment, consisting in a nocturnal splint, is indicated before the age of two years old. After this age, or in case of failure of splinting, surgery will be needed.     

Triphalangeal thumb

Triphalangeal thumb is often thought to be a rare congenital abnormality; it has an incidence of 1 in 25,000 births. We reviewed 49 triphalangeal thumbs in 28 Mexico City patients at the Diaz Lombardo Hospital from 1974 to 1979, Shriners Hospital from 1979 to 1982, Instituto Nacional de Ortopedia from 1981 to 1982, and at the ABC Hospital from 1971 to 1998. A total of 21 patients (75%) had bilateral deformity. Patients were classified according to Dieter Buck-Gramcko system and Müller teratologic line. All were surgically treated and evaluated with Cheng graduation scale, finding good results in 48 patients (97%), fair results in one (3%), and no poor results.     

Skier's thumb

Over a period of 9 years (1979-1988), more than 1000 patients have been seen in the Department of Hand Surgery with a tentative diagnosis of skier's thumb or a painful metacarpophalangeal of the thumb. Most injuries were treated conservatively, but 562 operations on the ulnar collateral ligament were done during this period. An X-ray Film was taken in all cases to exclude a fracture. The indications for an operation depend on the clinical symptoms. Swelling, pain just over the ulnar collateral ligament, and instability of the joint with a widening of the ulnar aspect of the joint of more than 30 degrees in comparison to the other hand are typical clinical symptoms, which together with the widening in the flexion position, prove a rupture of the collateral ligament. As part of our standard examination we take X-ray films of the hand in two projections to exclude a fracture, followed by abducted stress views in comparison to the other side. The best results were obtained when surgical therapy was performed within the first 8 days. Fractures of the base of the proximal phalanx of the thumb were operated on by pin wire fixation of the bone fragment in the anatomically correct position along with temporary transarticular pin wire arthrodesis. In ligamentous ruptures, periostal sutures together with a temporary arthrodesis were carried out. Old injuries without sufficient regeneration of the ligament and capsule necessitated plastic surgery using the long pulmar tendon or a PDS wire. In each case the joint was immobilized with a cast for 5-6 weeks, followed by active physiotherapy.     

Rheumatoid thumb

The hand is the main tactile sensory organ and is uniquely designed for fine motor activities. Any deviation from the normal architecture or limitation from a painful condition may lead to disability. Rheumatoid arthritis (RA) is fundamentally an inflammatory disease of the soft tissues. Deformities of the thumb arise from abnormal stretching of ligament and capsular structures as well as from ruptures and subluxations of the tendons. This article provides an overview of the types of deformities associated with, and surgical management of, RA of the thumb.     

Mallet thumb

The uncommon injury of mallet thumb is described, with four case reports. In diagnosis the condition must be distinguished from dropped thumb. Operative treatment is advised which, in this small series, gave excellent results.