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題名 | Free Fibular Osteo-septo-cutaneous Flap for Thumb Metacarpal Reconstruction--A Case Report=以游離腓骨複合皮瓣重建拇指掌骨之病例報告 |
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作者 | 施博淳; 李彥勳; 楊書瑜; 陳俊嘉; 楊振; 黃國峯; 林聿山; 劉澄; Shih, Po-chun; Lee, Yen-hsun; Yang, Shu-yu; Chen, Chun-chia; Yang, Cheng; Huang, Kuo-feng; Lin, Yu-shan; Liu, Cheng; |
期刊 | 臺灣整形外科醫學會雜誌 |
出版日期 | 20130900 |
卷期 | 22:3 2013.09[民102.09] |
頁次 | 頁260-271 |
分類號 | 416.615 |
語文 | eng |
關鍵詞 | 拇指掌骨; 游離腓骨複合皮瓣; Metacarpal reconstruction; Free fibular osteo-septo-cutaneous flap; |
中文摘要 | 背景:在手部的指頭中,拇指是最重要的。這是因為拇指有握拳跟對掌動作。拇指掌骨與其他的掌骨在構造上並不相同。拇指掌骨的頭側是自由活動與其他掌骨並不相連,基側則是鞍狀關節,這讓拇指可以做到對掌動作。拇指壓砸性創傷常造成掌骨粉碎性骨折及其周邊軟組織壞死或缺損。由於拇指在手部功能的必要性、掌指和掌腕關節的活動度較大,加上拇指附近軟組織,包括肌肉及肌腱構造的複雜性,使得姆指掌骨的重建變得十分重要卻困難。目的及目標:我們提出的案例是一位成人男性病患,因伐木工作意外,導致左拇指掌骨開放粉碎性骨折同時合併掌肌及橈側手背部皮膚的嚴重撕脫傷。後續以游離腓骨複合皮瓣重建拇指掌骨及其周邊軟組織。材料及方法:病患為四十八歲男性,於工作時,左手被倒下的樹幹撞擊壓傷。導致左拇指掌骨嚴重開放粉碎性骨折且合併掌肌及橈側手背部皮膚的撕脫傷。先緊急復位手術並以骨外固定器固定掌骨位置,以維持足夠的掌骨長度,同時減少軟組織的攣縮,再清創並將肌肉皮膚縫合。待傷口壞死邊界清楚後,再次施行清創手術,以利後續重建工作的順利進行。之後以游離腓骨複合皮瓣重建,利用鈦金屬骨板行內固定術。軟組織缺損部分,則以腓骨肌皮瓣之小腿外側皮瓣包覆。手術過程順利。結果:術後恢復過程良好,皮瓣無任何壞死。在術後兩年的復健追蹤治療發現,手部活動功能,可以做到握拳及用拇指和食指捏取小物品。左手握力可達42公斤,左大拇指運動範圍損失11.5%。病患順利重返工作職場。結論:重建拇指掌骨缺損是少見案例。手部功能以拇指最為重要,為確保後續骨癒合良好,先期以外固定器保持足夠的掌骨長度及空間,防止傷口攣縮。後續以游離腓骨肌皮瓣做為重建之選擇,可以達到一個良好的效果,病人也高度的滿意。 |
英文摘要 | Background:The thumb is opposable and prehensile, making it the most unique digit of the hand. In particular, the metacarpus of the thumb is different from the other digits, with a free head and trumpet-shaped base that provide a higher range of motion for opposability. Composite defects of the hand, especially those involving the first metacarpus, often result in severe functional disability and a challenging reconstruction.Aim and Objectives:We present a case in which a composite defect involving the first metacarpus and surrounding soft tissues was reconstructed using a staged free fibular osteo-septocutaneous flap.Materials and Methods:A 48-year-old man sustained crush injury of the left hand, due to the fall of a tree, resulting in a complex defect with a comminuted open fracture of the first metacarpus and surrounding soft tissue avulsion. Initially, open reduction and external fixation was performed to prevent soft tissue contracture, followed by debridement. Further reconstruction was undertaken using free fibular osteo-septo-cutaneous flap with internal fixation using titanium micro-plates.Results:The flap and donor sites healed well. The patient was able to make a fist and pinch between the thumb and fingers. He returned to work with 42 kg of grip strength and 11.5% loss of total thumb motion.Conclusion:Reconstruction of a composite defect involving the first metacarpus is rare and difficult. To ensure good bony union, we recommend initially using external fixation to prevent soft tissue contracture and then performing a free fibular osteo-septo-cutaneous flap transfer with internal fixation using titanium micro-plates. |
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