The thumb plays a vital role in the function of the hand, and it is inseparable from conventional movements such as gripping, pinching and counter-fingers. Without the thumb, 50% of the function of the hand will be lost, which will seriously affect daily life and work.
Recently, the third district of the Department of Orthopedics of Qingyuan People's Hospital successfully implemented the first case of full thumb reconstruction in Qingyuan area for the full shape reconstruction of the thumb of Ms. Sun, a patient with a broken finger. The successful development of this technology marks a new level of microsurgery technology in the hospital.
Ms. Sun, a worker, was hospitalized in the third district of the Orthopedic Department of Qingyuan People's Hospital in February this year due to an accident and her hands were crushed by a machine.
"At that time, the damage to the patient's hands was relatively serious, especially the right hand, multiple fingers were broken, and soft tissues were seriously contused." Kwong Yizhen, a doctor in the third district of the orthopedic department of the hospital, introduced that the patient's middle knuckle of the 2-3 finger and the proximal knuckle of the 4th to 5th finger of the left hand were broken, leaving only a little skin on the palm side; the thumb and 3-5 finger of the right hand were completely broken, and the back of the hand and the palm of the hand were seriously damaged.
The patient had a strong desire to restore the function of the hands, and at that time, the third area of the orthopedic department immediately performed a phase of surgery for the patient, such as debridement and suturing of the wounds of the hands, replantation of the left little finger, replanting the broken finger of the middle finger, and repairing the stump of the right hand.
Xia Xiaodan, director of the third district of the Department of Orthopedics, said: "Because the ring finger of the patient's left hand is relatively intact, in the first stage of surgery, we transplanted the ring finger of the patient's left hand to the position of the middle finger. He explained that compared with the ring finger, the middle finger plays a higher proportion of the hand function and can restore the left hand function to a greater extent.
Because the patient's right hand was badly damaged, about 10 days after the first stage of surgery, the second stage of surgery was performed. The operation mainly performed the right anterolateral free flap resection graft, venous transplant anastomosis + right thumb-to-palm function reconstruction, covering the wound and reconstructing part of the thumb function, and also laying the foundation for the reconstruction of the shape and function of the thumb in stage III.
"If the patient's right thumb, middle, ring, and little finger are absent, the right hand function is reduced by 70%-80%." Xia Xiaodan said that patients have very high requirements for the reconstruction and recovery of right hand function, but the reconstruction of the right thumb needs to wait for the blood flow of the flap and the wound to stabilize before proceeding to the next step of surgery, otherwise it will affect the blood flow of the flap.
About 4 months after the second stage of surgery, the wound of the patient's right hand recovered well, and the flap blood transport was established and stabilized, which met the indications for surgery. The goal of the surgery is to reconstruct the right thumb and restore some hand function while reducing damage to the donor area.
There are several ways of thumb reconstruction surgery, Xia Xiaodan and his team discussed, chose the full thumb flap transplant thumb reconstruction method to reconstruct the thumb, with the ilioin inguinal flap transplantation to repair the foot supply area. He said that this method is more aesthetically pleasing and has less impact on the foot supply area than the "toe moving" type of extensive surgery.
Xia Xiaodan said: "We only take the flap of the thumb, the part of the nail, the bone and tendon are retained, and do not destroy the tendon, bone system and weight-bearing function of the thumb of the foot. ”
The advantages are many, and the difficulties follow. On the one hand, the thumb flap transplantation needs to have overall design requirements, and the size and position of the supply and reception areas must be in line with. On the other hand, the difficulty of surgery will also increase accordingly, and the requirements for doctor microsurgical techniques are higher, and the anastomosis such as blood vessels and flaps should be precisely docked, otherwise it will lead to necrosis of the transplanted tissue.
After 6 hours and 3 surgical teams, the required tissue was successfully removed and reconstructed on the thumb of the right hand, and the appearance was close to that of a normal finger. After the operation, under the careful observation and care of the medical team, Ms. Sun's thumb gradually recovered and finally survived smoothly. At present, patients are already able to perform simple hand activities such as eating and writing.
【Written by】 Chen Zhiyu Liu Qiuyi
[Correspondent] Peng Keming
【Author】
【Source】 Southern Press Media Group South + client
Source: South+ - Create more value