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Reversed vascularized second metatarsal flap for reconstruction of Manske type IIIB and IV thumb hypoplasia with reduced donor site morbidity.
Tong, De-Di; Wu, Le-Hao; Li, Peng-Cheng; Rong, Yan-Bo; Liu, Bo; Lee, WPAndrew; Wei, Qi-Pei; Liu, Lu; Miao, He-Jia; Chen, Shan-Lin.
Afiliação
  • Tong DD; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Wu LH; Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Beijing 100144, China.
  • Li PC; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Rong YB; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Liu B; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Lee W; Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
  • Wei QP; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Liu L; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Miao HJ; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
  • Chen SL; Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
Chin Med J (Engl) ; 132(21): 2565-2571, 2019 Nov 05.
Article em En | MEDLINE | ID: mdl-31592906
BACKGROUND: The predominant method for Manske type IIIB and IV thumb hypoplasia is pollicization. However, for those who are not willing to sacrifice the index finger, a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable. This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative. METHODS: From May 2014 to January 2017, 15 patients with Manske type IIIB or IV thumb hypoplasia who were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital were included in this study. An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint. The donor site was reconstructed by a split half of the third metatarsal. Various functional reconstructions were commenced at second stage. The reconstructed thumbs were evaluated using the Kapandji score, pinch force, and the capacities of performing daily activities through a detailed questionnaire. RESULTS: Among these 15 patients (seven type IIIB and eight type IV), there were ten boys and five girls with median age of 4.2 years (range: 2.0-7.0 years). There were seven right, three left, and five bilateral thumbs for whom only the right thumb received surgery. There were 14 metatarsal flaps survived (14/15). With an average follow-up of 19.2 months, the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function. All 15 children have improved the Kapandji score (from 0 to an average of 6.7), pinch force (from 0 to an average of 1.5 kg), with ability of grip and pen holding. X-ray indicated continuous bone growth. Patients and parents had good acceptance of the new thumb. CONCLUSIONS: Reconstruction of an unstable hypoplastic thumb (Manske type IIIB and IV) with use of a vascularized metatarsal is an effective strategy. It offers an alternative solution for parents insisting on saving the thumb.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Polegar / Deformidades da Mão Limite: Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Chin Med J (Engl) Ano de publicação: 2019 Tipo de documento: Article País de afiliação: China País de publicação: China

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Polegar / Deformidades da Mão Limite: Child / Child, preschool / Female / Humans / Male Idioma: En Revista: Chin Med J (Engl) Ano de publicação: 2019 Tipo de documento: Article País de afiliação: China País de publicação: China