The Study Of Holomorph Reconstruction Of Thumb Defect Combined With Microreconstruction Of Donor Site

Background:Thumb defects due to various reasons affect the function of the hand, cause high morbidity rate. The patients’physical and mental suffered great injury.Thumb reconstruction methods commonly used at home and abroad are the2nd toe free transplantation, great toe-to-thumb transfer,etc.But these methods often need to sacrifice for the toes.And after the reconstruction of thumb, the shape and function are difficult to fully meet the requirements of patients.Research about the thumb reconstruction at home and abroad generally focuses on the thumb reconstruction methods, less on donor site repairing.This project has a huge role in promoting on improving the shape and function of reconstructed thumb, reducing disability degree of the donor foot, relieving patients’ physiological and psychological burden.Objectives:This project is composed of an anatomic and a clinical study. The purpose of the anatomic study is to get the results of locations and amounts of the cutaneous perforators, the location and diameter of the free superficial circumflex iliac perforator flap (SCIP) through dissection of5cadavers. In the clinical study,20patients with a thumb defect will be treated with a new procedure which an iliac bone covered with a free wrap around flap is reconstructed as a new thumb and the donor site of foot is repaired with SCIP at the same time. And the purpose of this clinical study is to summarize the advantages and disadvantages of this new procedure through the evaluation of the follow-up outcomes.Methods:Anatomic study is that the entering skin point,the number of perforating branches, artery position, diameter and ansomosis of superficial circumflex iliac artery in the ilioinguinal region were observed in10specimen of5adult corpses perfused with red latex through artery.Clinical from November2013,there were20cases of thumb defect,all were treated with combined transfer of big wrap-aroud flap and autogenous iliac graft for thumb reconstruction,while a superficial cirumflex iliac artery perforator flap was used to resurface the donor defect,the donor sit of the belly was sutured directly,appearance,sensation and function of the thumb and foot flap were followed-up..Results:Superficial iliac circumflex artery originates from femoral artery which is about2.5cm below inguinal ligamentlts accompanying vein is about2.5cm below inguinal ligment and originates from the accompanying vein of femoral artery,which is divided into shallow and deep branch outside1.5cm of the femoral artery. The shallow branch then pierces through deep fascia and goes to anterior superior spine,which gives out the first cutaneous perforator5cm away from the starting point and then gives out one cutaneous perforator every2cm,including4to5perforating branches.The deep branch continues to run to upper and outside direction under the deep fascia and gives out muscular branch as well as cutaneous perforator on the way.It comes out deep fascia from outside the artorius muscle and gives out from the front and outer place of cutaneous branch nutrition groin.The shallow branch is of big variation and the deep one is usually constant with relatively thick external diameter.Its terminal branch gives out the skin around anterior spine of cutaneous branches nutrition iliac as well as periosteal branch nutrition iliac crest proparea.20clinical cases showed that reconstruction thumb survived smoothly.Two cases of flap showed arterial crisis and two of them showed vein crisis.All of them survived after examination.It has been obseved3to10moths after operation.The reconstruction thumb has favorable appearance,and its opposition function was good and sensation recovery to S3+and two-point discrimination from6-8mm.According to the hand function assessment standard from Hand Surgery Association of Chinese Medical Association,15of them are excellent and5of them are good.The excellent and good rate reach100%.Thumbs from donor site have satisfying flap color and texture but are a little fat,while it does not affect walking.Four patients accepted falp reconditioning and enjoyed better appearance.,leaving only a linear scar on the belly with no apparent discomfort.Conclusions:There are several permanent perforators on the superficial circumflex iliac artery and the size of the vessel diameter is big enough for microsurgical repair. It is an effective method of combined transfer of big toe wrap-around flap and autogenous iliac graft while a superficial circumflex iliac artery perforator flap was used to resurface the donor defect used to reconstrucution of thumb defect.Not only the renconstructived thumb has good appearance and function, but also the length of the donor big-toe is reserved.All the patients had no effec on walking and running.There was only one linear scar on the belly donor without any discomfort.It is worth clinical popularization and application.