带前臂外侧皮神经营养血管皮瓣修复虎口缺损

目的探讨带前臂外侧皮神经营养血管皮瓣修复虎口部软组织缺损的方法。方法应用带前臂外侧皮神经营养血管皮瓣修复虎口部软组织缺损、瘢痕挛缩10例,皮瓣修复创面面积12cm×8cm～3cm×4cm。结果术后随访1～3年,9例皮瓣全部成活,1例远端出现部分坏死,皮瓣美观,外观满意,感觉及手功能恢复满意。结论带前臂皮神经营养血管皮瓣修复虎口软组织缺损具有操作简便、血供丰富、质地薄、感觉恢复好、无需再次整形等优点,为修复虎口软组织缺损提供了一种新的方法。     

拇指桡背侧皮神经营养血管皮瓣瓦合邻指皮瓣修复拇指末节脱套样软组织缺损

目的：探讨拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复拇指末节脱套样软组织缺损的临床治疗效果。方法：2017年10月-2021年2月,笔者医院对12例拇指末节脱套样软组织缺损患者采用拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复,创面面积2.0cm×5.5cm～3.5cm×7.5cm,门诊随访皮瓣外观与感觉、手功能及术后并发症情况。结果：拇指桡背侧皮神经营养血管皮瓣切取范围为2.0cm×2.0cm～3.5cm×4.0cm,示指近节背侧邻指皮瓣切取范围为1.5cm×2.0cm～3.0cm×3.5cm。术后随访6～18个月,平均9.4个月,11例拇指桡背侧皮神经营养血管皮瓣及10例邻指皮瓣成活良好,伤口甲级愈合。远期随访,10例拇指指腹饱满,外观满意,2例拇指指尖皮瓣萎缩。12例皮瓣供区均愈合良好,无明显瘢痕增生,功能恢复良好。12例拇指恢复良好的对捏及对掌功能,拇指指腹两点感觉辨别试验为7～16mm,指背两点感觉辨别试验为6～11mm。评定手功能：优8例,良2例,中2例。结论：拇指桡背侧皮神经营养血管皮瓣与示指背邻指皮瓣瓦合修复拇指末节脱套样软组织缺损,手术操作简便、安全,...     

拇指背侧皮神经营养血管逆行皮瓣修复拇指软组织缺损

目的探讨吻合神经的拇指背侧皮神经营养血管逆行皮瓣修复拇指软组织缺损的临床效果及并发症的防治。方法利用拇指背侧皮神经营养血管逆行皮瓣修复拇指软组织缺损23例,11例将皮瓣内皮神经与受区内指神经外膜吻合,以重建受区感觉。结果23例皮瓣手术,22例皮瓣成活,1例皮瓣远端部分坏死。6例皮瓣远端出现张力性水泡,经积极处理后缓解。术后随访4～24个月,1例发生嵌甲,2例出现虎口轻度挛缩,成活皮瓣质地良好,手部外形与功能恢复满意,皮瓣恢复保护性感觉。结论该皮瓣手术操作简单,皮瓣外形好,可恢复部分感觉,是修复拇指软组织缺损的理想皮瓣。     

皮神经营养血管逆行皮瓣修复手部软组织缺损

目的 探讨以指动脉或尺动脉远端皮穿支为蒂的皮神经营养血管逆行皮瓣,修复手部软组织缺损的手术方法 和临床疗效.方法 根据缺损部位的不同,分别对32例手部皮肤软组织缺损进行修复,其中采用指动脉背侧穿支蒂指神经背侧支逆行皮瓣5例,拇指动脉背侧穿支蒂的拇尺背侧皮神经营养血管逆行皮瓣15例,指动脉指蹼穿支蒂的手背皮神经营养血管逆行皮瓣7例,尺动脉腕上皮穿支蒂的前臂内侧皮神经营养血管逆行皮瓣修复5例.皮瓣切取面积为1.9 cm×2.0 cm～7.0 cm×10.0 cm.在修复指腹软组织缺损的患者中,将皮瓣中的皮神经与受区掌侧指神经缝合12例.结果 除1例皮瓣远端部分静脉回流障碍外,其余皮瓣均存活.术后随访时间为3个月～4年,皮瓣外形满意,手功能恢复良好.12例缝合指神经者,皮瓣两点分辨觉为10～12 mm.结论 穿支蒂皮神经营养血管皮瓣手术简便,血供可靠,可重建感觉功能,是修复手部创面的良好方法.     

虎口部皮肤软组织缺损的显微外科修复

目的总结虎口部皮肤软组织缺损的外科皮瓣修复的临床效果。方法1998—2004年应用皮瓣修复虎口部皮肤软组织缺损21例，其中腹部带蒂皮瓣4例，前臂骨间动脉筋膜皮瓣4例，前臂背侧皮神经营养血管皮瓣7例，第一掌背皮神经营养血管皮瓣3例，第一趾蹼皮瓣游离移植3例。结果术后有1例皮瓣远端小部分坏死，经换药后愈合，其余皮瓣全部成活。随访6～12个月，皮瓣质地良好，手功能恢复满意。结论对于虎口皮肤软组织缺损，应用显微外科修复，皮瓣质地及术后手部外观、拇指活动功能的恢复均较好。正确选择皮瓣、及时防治血管危象是取得良好疗效的关键。     

同指两叶复合皮瓣瓦合修复拇指软组织缺损

目的 介绍同指两叶复合皮瓣瓦合修复拇指软组织缺损的方法. 方法 自2005年2月至2009年5月,对8例拇指软组织缺损采用同拇指桡侧筋膜皮瓣覆盖缺损桡侧,尺背侧皮神经营养血管皮瓣覆盖缺损尺侧,两叶皮瓣瓦合同时修复拇指.皮瓣切取面积:一叶为3.8 cm×2.4 cm ～ 4.0 cm×2.6 cm,另一叶为3.8 cm×2.3 cm～4.1cm×2.6 cm. 结果 8例双叶皮瓣全部成活,6～12个月随访,皮瓣质地优良,外形佳,拇指指间、掌指关节运动正常,虎口未见挛缩,两点辨别觉为5.0～8.0 mm,感觉测定为S2～S4+. 结论 该方法切取简便,损伤小,转移灵活,皮瓣外形佳,功能满意,重建皮瓣的感觉好,对供区损伤小,为修复拇指软组织缺损提供了一种较为理想的方法.     

拇指桡背侧皮神经营养皮瓣修复拇指皮肤软组织缺损

目的探讨拇指背桡侧皮神经营养血管蒂的岛状皮瓣修复拇指软组织缺损的临床效果。方法对19例拇指软组织缺损患者利用拇指背桡侧皮神经营养血管皮瓣修复,其中修复感觉神经15例。缺损面积：1.5cm×1.0cm～2.5cm×2.5cm;皮瓣面积：2.0cm×1.5cm～3.0cm×2.5cm。结果19例皮瓣全部成活。随访5～30个月,皮瓣外观及感觉良好,指腹两点分辨觉为6～10mm。指间关节活动范围0°～80°。结论该皮神经皮瓣手术操作简单,皮瓣外形好,部分皮瓣能恢复感觉,是修复拇指软组织缺损的理想方法。     

吻合神经的手部皮神经营养血管皮瓣修复指端软组织缺损

目的 报道应用吻合神经的手部皮神经营养血管皮瓣修复手指指端软组织缺损的临床效果.方法 采用掌背皮神经营养血管皮瓣掌侧移位修复拇指指端软组织缺损;拇指尺背侧皮神经营养血管皮瓣修复示指指端软组织缺损:中、环、小指指背皮神经营养血管皮瓣修复相应指端软组织缺损;共修复指端软组织缺损56例. 结果 皮瓣全部成活,随访6个月～3年,皮瓣质地柔软、弹性好、耐磨;指端饱满,色泽正常,两点辨别觉5.4～9.6 mm,45例感觉恢复至S3,11例至S4,外观及功能满意.结论 应用吻合神经的手部皮神经营养血管皮瓣修复手指指端软组织缺损,效果良好.     

拇指背侧皮神经营养血管蒂岛状皮瓣修复拇指指端缺损

目的探讨拇指背侧带皮神经营养血管蒂岛状皮瓣修复拇指指端缺损的临床效果。方法利用带拇指桡背侧或尺背侧皮神经营养血管蒂岛状皮瓣修复拇指指端软组织缺损12例。结果12例皮瓣全部成活,经6～24个月随访,拇指外形和功能恢复良好。结论拇指背侧皮神经营养血管蒂岛状皮瓣具有操作简单、成活率高、外形恢复满意等优点,是修复拇指指端缺损的理想方法。     

应用拇指背侧皮神经营养血管逆行皮瓣修复拇指皮肤软组织缺损

目的 探讨拇指桡、尺背侧神经营养血管皮瓣修复拇指创面的适应证、临床疗效和并发症的防治措施.方法 对24例外伤引起的拇指皮肤软组织缺损患者,创面大小为1 cm×2 cm～3 cm×5 cm,采用逆行拇指背侧神经营养血管皮瓣转移修复.其中8例修复拇指指腹缺损患者中,将皮瓣内皮神经与拇指指神经吻合.结果 5例术后出现皮瓣远端静脉回流障碍,经采取拆除部分缝线,应用肝素生理盐水擦拭皮瓣边缘等应对措施后均未发生皮瓣坏死.平均随访13个月,所有皮瓣均存活,并恢复保护性感觉,其中吻合神经的皮瓣两点辨别觉为8～10 mm.结论 拇指背侧神经营养血管逆行皮瓣是修复拇指掌指关节以远任何部位创面的良好选择,吻合皮瓣内的皮神经能较好地恢复皮瓣的感觉.     

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.     

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.     

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.