UPPER LIMB FREE FLAP FOR REPAIR OF SEVERE CONTRACTURE OF THUMB WEB AND ONE STAGE RECONSTRUCTION OF INDEX FINGER ABDUCTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIN Rihao ¹ , LIN Geliang ¹ , CHEN Kangcha ¹ , JIN Yu ²

1Department of Hand Surgery, Xiaolan Hospital of Southern Medical University, Zhongshan Guangdong, 528415, P.R.China;;
2Department of Anatomy, Medical College of Yanbian University. Corresponding author: JIN Yu, E-mail: jinyu@ybu.edu.cn;

Corresponding author：

Keywords：

Upper limb free flap; Contracture of thumb web; Index finger abduction; Functional reconstruction

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ObjectiveTo evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction. MethodsBetween March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25° (mean, 20°), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm × 4 cm to 8 cm × 6 cm; the upper limb free flap from 7 cm × 5 cm to 9 cm × 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting. ResultsAll the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90° (mean, 88°). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered. Conclusion A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.

Citation： JIN Rihao,LIN Geliang,CHEN Kangcha,JIN Yu. UPPER LIMB FREE FLAP FOR REPAIR OF SEVERE CONTRACTURE OF THUMB WEB AND ONE STAGE RECONSTRUCTION OF INDEX FINGER ABDUCTION. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(9): 1071-1073. doi: Copy

1.	潘生德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
2.	邵新中, 朱稷兴, 吕莉, 等. 显微外科治疗重度虎口挛缩的疗效分析. 中华显微外科杂志, 2010, 33(2): 95-97, 179.
3.	芮永军, 施海峰, 张全荣, 等. 手部挤压伤后虎口挛缩的早期防治. 中华显微外科杂志, 2010, 33(2): 101-103.
4.	路来金, 宫旭, 余新, 等. 虎口挛缩的皮瓣修复. 中华显微外科杂志, 2010, 33(2): 110-111.
5.	韩金豹, 高宏阳, 杨磊, 等. 髂腹股沟皮瓣修复虎口挛缩及一期拇对掌功能重建. 中国修复重建外科杂志, 2007, 21(4): 346-348.
6.	邱旭东, 赵维彦, 赵世伟, 等. 骨间背侧动脉皮瓣修复严重虎口挛缩的临床应用. 中华显微外科杂志, 2009, 32(2): 169.
7.	滕国栋, 汤海萍, 方源, 等. 骨间背侧动脉岛状皮瓣治疗虎口狭窄的疗效分析. 中华显微外科杂志, 2010, 33(2): 98-100.
8.	魏海温, 江海延, 赵志刚, 等. 骨间背侧动脉岛状皮瓣的临床应用. 实用手外科杂志, 2007, 21(1): 37.
9.	Sauerbier M, Glessler GA, Germann G, et al. Applications of free lateral arm flap for hand and forearm defect reconstruction. Unfallchirurg, 2010, 113(10): 821-831.
10.	李学渊, 王欣, 陈宏, 等. 游离上臂外侧皮瓣在手部皮肤缺损中的应用. 中华手外科杂志, 2009, 25(2): 69-70.
11.	杨卫玺, 李春江, 王一兵, 等. 游离上臂外侧皮瓣修复手部深度烧伤. 中华显微外科杂志, 2010, 33(5): 436.
12.	刘光军, 郭升玲, 谭琪, 等. 带感觉的上臂外侧皮瓣游离移植修复手部皮肤缺损. 实用手外科杂志, 2011, 25(4): 281-283.
13.	Windhofer C, Michlits P, Karlbauer A, et al. Treatment of segment bone and soft-tissue defects of the forearm with the free osteocutaneous lateral arm flap. J Trauma, 2011, 70(5): 1286-1290.
14.	聂振军, 李东, 刘雷, 等. 上臂外侧游离皮瓣治疗重度虎口瘢痕挛缩. 中国美容整形外科杂志, 2011, 22(6): 357-359.
15.	Ng SW, Teoh LC, Lee YL, et al. Contralateral pedicled lateral arm flap for hand reconstruction. Ann Plast Surg, 2010, 64(2): 159-163.

1. 潘生德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
2. 邵新中, 朱稷兴, 吕莉, 等. 显微外科治疗重度虎口挛缩的疗效分析. 中华显微外科杂志, 2010, 33(2): 95-97, 179.
3. 芮永军, 施海峰, 张全荣, 等. 手部挤压伤后虎口挛缩的早期防治. 中华显微外科杂志, 2010, 33(2): 101-103.
4. 路来金, 宫旭, 余新, 等. 虎口挛缩的皮瓣修复. 中华显微外科杂志, 2010, 33(2): 110-111.
5. 韩金豹, 高宏阳, 杨磊, 等. 髂腹股沟皮瓣修复虎口挛缩及一期拇对掌功能重建. 中国修复重建外科杂志, 2007, 21(4): 346-348.
6. 邱旭东, 赵维彦, 赵世伟, 等. 骨间背侧动脉皮瓣修复严重虎口挛缩的临床应用. 中华显微外科杂志, 2009, 32(2): 169.
7. 滕国栋, 汤海萍, 方源, 等. 骨间背侧动脉岛状皮瓣治疗虎口狭窄的疗效分析. 中华显微外科杂志, 2010, 33(2): 98-100.
8. 魏海温, 江海延, 赵志刚, 等. 骨间背侧动脉岛状皮瓣的临床应用. 实用手外科杂志, 2007, 21(1): 37.
9. Sauerbier M, Glessler GA, Germann G, et al. Applications of free lateral arm flap for hand and forearm defect reconstruction. Unfallchirurg, 2010, 113(10): 821-831.
10. 李学渊, 王欣, 陈宏, 等. 游离上臂外侧皮瓣在手部皮肤缺损中的应用. 中华手外科杂志, 2009, 25(2): 69-70.
11. 杨卫玺, 李春江, 王一兵, 等. 游离上臂外侧皮瓣修复手部深度烧伤. 中华显微外科杂志, 2010, 33(5): 436.
12. 刘光军, 郭升玲, 谭琪, 等. 带感觉的上臂外侧皮瓣游离移植修复手部皮肤缺损. 实用手外科杂志, 2011, 25(4): 281-283.
13. Windhofer C, Michlits P, Karlbauer A, et al. Treatment of segment bone and soft-tissue defects of the forearm with the free osteocutaneous lateral arm flap. J Trauma, 2011, 70(5): 1286-1290.
14. 聂振军, 李东, 刘雷, 等. 上臂外侧游离皮瓣治疗重度虎口瘢痕挛缩. 中国美容整形外科杂志, 2011, 22(6): 357-359.
15. Ng SW, Teoh LC, Lee YL, et al. Contralateral pedicled lateral arm flap for hand reconstruction. Ann Plast Surg, 2010, 64(2): 159-163.

Chinese Journal of Reparative and Reconstructive Surgery

UPPER LIMB FREE FLAP FOR REPAIR OF SEVERE CONTRACTURE OF THUMB WEB AND ONE STAGE RECONSTRUCTION OF INDEX FINGER ABDUCTION

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