Assessment of soft tissue reconstruction of the thumb after injuries

Authors

  • Shawky Shaker Gad Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Tarek Fouad Keshk Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Ahmed Tharwat Nassar Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Hassan Gaber Zaki Bassiouny Department of Plastic and Reconstructive Surgery, Al-Ahrar Zagazig Teaching Hospitals, Zagazig, Egypt

DOI:

https://doi.org/10.18203/2349-2902.isj20200805

Keywords:

Complication, Injuries, Reconstruction, Soft tissue, Thumb

Abstract

Background: This study is to formulate a strategic approach for soft tissue reconstruction of the thumb and study of different modalities of soft tissue reconstruction of the thumb and try to clarify advantage and discuss complication of each modality.

Methods: This is a prospective study done on 20 patients with thumb defects and deformities, presented at Menoufia University and Al-Ahrar Zagazig Teaching Hospitals during the period from January 2017 to July 2019. They were 14 Males and 6 females classified according to age, sex, type of trauma, dominant hand, type of flap used for reconstruction.

Results: The most type of injury was trauma in all technique accept digital artery perforator (DAP) flap and groin flap of the half patients were trauma (50%) and other half were post burn (50%).  Most patients were early timing of interference in all techniques accept replantation was immediate time of interference (100%) and groin flap was late time of interference (100%). Most patients in Moberg flap had minimal scare complication (60%). Whereas half patients had minimal scare complication in replantation, little flap and DAP flap (50%, 50% and 50%). While half patients had volar contracture, graft complication in thumb cross finger and groin flap (50% and 50%).

Conclusions: Replantation is the first choice for thumb amputations proximal to the base of the distal phalanx. It is impossible or fails, other methods of thumb reconstruction. Thumb cross finger flap is an excellent reconstructive technique for larger volar and tip defects of the thumb, up to 2-3 cm2.

Author Biography

Shawky Shaker Gad, Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt

Department of General Surgery, Al-ahrar Zagazig Teaching Hospitals, Zagazig, Egypt

References

Slocum DB, Pratt DR. Disability evaluation for the hand. J. Bone Joint Surg. 1946;28:491-5.

Emerson ET, Krizek TJ, Greenwald DP. Anatomy, physiology, and functional restoration of the thumb. Ann. Plast. Surg. 1996;36(2):180-91.

Bueno RA, Wilhelmi BJ. Thumb reconstruction; 2007.

Voiget C. Tendon injuries of the hand. Chirurg. 2002;73(7):744-64.

Soutar D, Tanner N. The radial forearm flap in the management of soft tissue injuries of the hand. Br J Plast Surg. 1984;37(1):18-26.

Livingston CK, Ruis-Razura A, Cohen BE. Guidelines for a successful microsurgery training center and research fellowship. Plast Reconstr Surg. 1999;104(5):1555-8.

Lee A, Salyapongse N. Thumb reconstruction. Green’s Operative Hand Surg. 2005;2:1865-6.

Congress I. World society for reconstructive microsurgery (wsrm) inaugural congress. J Reconstruc Microsurg. 2002;18(3):20-8.

Littler JW. Reconstruction of the thumb in traumatic loss. In: Converse JM, ed. Reconstructive Plastic Surgery. Philadelphia: Saunders; 1977: 33-52.

Manketlow RT, Zuker RM, Mckee NH. Functioning free muscle transplantation. J Hand Surg. 1984;9(1):32-9.

Vikki SK. Distraction and microvascular epiphysis transfer for radial club hand. J Hand Surg Br. 1998;23(4):445-52.

Petkoval L. Dynamics and characteristics of industrial traumatism among shipbuilding workers. Higiena Izdraveopanze. 1984;27:194.

Eski M, Nisanci M, Sengezer M. Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap J Hand Surg. 2007;33:65-71.

Al-Baz TH, Gad SS, Keshk TF, Aly MS. Evaluation of dorsal metacarpal artery perforator flaps in the reconstruction of hand soft-tissue defects. Menoufia Med J. 2019;32(4):125-6.

Adani R, Squarzina P, Castagentti C, Lagami, Pancaldi D. A Comparative study of the heterodigital neurovascular island flap in thumb construction with and without nerve reconstruction; J Hand Surg. 1995;19:55-62.

Lemmon JA, Janis JE, Rohrich RJ. (Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg. 2008;228:105-17.

Katsaros J. Indications of soft tissue free flap transfer to the upper limb and the role of alternativeprocedures. Hand Clincs. 1992;8(3):479-507.

Downloads

Published

2020-02-26

Issue

Section

Original Research Articles