ABSTRACT
Objective@#To explore the efficiency and effect of radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus to reconstruct thumb complex defects.@*Methods@#5 cases of thumb complex tissue defects patients admitted to Xiangya Hospital of Central South University from June 2014 to October 2018. The patients were all male and aged from 35 to 63 years (average age was 47 years). There were 2 cases of right thumb and 3 cases of left thumb. The skin defect area was from 16.0 cm×4.0 cm to 3.5 cm×2.0 cm, and the bone defect length was 2-3 cm.All defects were reconstructed with radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus. The sizes of perforator flap were from 4 cm×2 cm to 18 cm×5 cm, and the sizes of bone were from 2.0 cm×0.6 cm×0.5 cm to 2.5 cm×1.0 cm×0.5 cm.The posterior branchial cutaneous of the arm was included in skin flap. 2 flaps underlied microdissect to defat. After fixing bone flap and finger/metacarpal bone with Kirschner wires, the radial accessory vessels were anastomosed with the radial vessels and cephalic vein at the nasopharyngeal fossa.All donor sites were closed directly.@*Results@#All flaps survived uneventfully. Kirschner wires were removed 4 to 6 weeks after operation. Postoperative follow-up ranged from 3 months to 4.5 years (average 19 months). All bone aps healed without union. Functions of thumb opposition and thumb to finger were all good. The hand function had excellent result in 3 cases and good in 2 cases. Sensory recovered to S4 in 1 case, S3 in 3 cases and S2 in 1 case. Evaluation of the appearance satisfaction of patients was 5 points in 3 cases and 4 points in 2 cases.@*Conclusions@#The radial collateral artery chimeric perforator flap combining a vascularized fragment of the distal humerus, which can reconstruct skin soft tissue and bone simultaneously, has good postoperative feeling and function recovery, and satisfactory appearance, and is an effective method to repair the defect of thumb complex tissue.
ABSTRACT
Se presentó un paciente blanco, de 35 años de edad, que sufrió accidente de trabajo en una impresora que le provocó lesión del pulgar, fue atendido en el Cuerpo de Guardia del Hospital Universitario Docente Vladimir Ilich Lenin de Holguín y se le realizó un colgajo pediculado al hemiabdomen superior permaneciendo por cuatro semanas y al liberarlo logró buena revascularización y función. El paciente se incorporó a sus labores normalmente tres meses después del accidente. El paciente realiza la pinza digital y escribe con su mano diestra lesionada.
A white patient of 35 years old, who suffered an accident at work on a printer that caused injury to the thumb, was presented. He was treated at the Emergency Service of Vladimir Ilich Lenin University Teaching Hospital of Holguin, to whom a pedicle flap to the upper abdomen was performed remaining for four weeks and underwent and a good revascularization and function was achieved. The patient did his work normally three months after the accident. The patient performs the digital clamp and writes with his injured right hand
ABSTRACT
Results: All incisions healed by first intention. Ten cases of thumb reimplantation were successful. All the patients were followed up for 5 months to 2 years and 8 months, with an average of 1 year and 4 months. Two-point discrimination was 3-9 mm (mean, 6.8 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the sensory of the thumb was rated as S 4 in 18 cases and S3+ in 5 cases; the sensory at donor sites recovered to S3. Conclusion Transferring the ulnaris proper digital nerve of index finger and its dorsal branch to repair the thumb nerve avulsion is a simple and effective method to restore sensory function of the thumb pulp.