| Objective: To explore the clinical effects of three commonly used thumb reconstruction methods including the combined to wrap-around flap combined with the second toe joint tendon combination,the combined wrap-around flap combined with the iliac bone,and the second toe transplantation in the repair of thumb ?-? degree defects.Methods: Retrospective analysis of patients with thumb ?-? degree defects who underwent thumb reconstruction surgery in our hospital's hand surgery from September 2016 to November 2019.According to the different surgical methods,54 patients were divided into three groups.Group A consisted of 18 cases of thumb reconstruction with wrap-around flap combined with the second toe joint tendon,including 12 males,6 females,and 5 ? degrees,13 ? degrees,aged 19-56 years;Group B consisted of 18 cases of thumb reconstruction with wrap-around flap combined with iliac bone,including 11 males,7 females,6 ? degrees,12 ? degrees,and 20-57 years old;Group C consisted of 18 cases of reconstructed thumb with second toe simply transplanted,including 12 males,6 females,5?degrees,13? degrees,and 20-57 years old.All patients had no difference in preparation before operation and postoperative rehabilitation.The operation was completed in cooperation with the same group of physicians.The follow-up period was 3 months to 43 months.Observation and statistics of the length of hospitalization;operation time;reconstructed thumb function score;appearance score;incidence of infection,hematoma,flap necrosis or partial necrosis;American Orthopedic Foot and Ankle Society(AOFAS)for hallux metatarsophalangeal-interphalangeal score in three groups.Results: 1?There was no statistical difference in the general conditions(age,gender,and type)of the three groups of patients(P> 0.05).2?Comparison of the length of stay in the three groups of patients: 17.33 days ± 3.63 in group A,18.00 days ± 5.05 in group B,and 10.17 days ± 3.37 in group C.The data of the three groups are normal distribution data,the variance is equal,F = 20.358,P <0.001,the differences between the three groups are statistically significant,and further comparisons can be made in pairs.There was no statistical difference between group A and group B(p = 0.626 > 0.05).Compared between group A and group C(P <0.001)was statistical significance.Comparison between group B and group C(P <0.001)was statistically significant.3?Comparison of the time-consuming operation of the three groups,group A 10.86 h ± 0.87,group B 9.28 h ± 0.62,group C 3.49 h ± 0.59.The data of the three groups belong to the normal distribution? data,the variance is equal,F = 542.38 P < 0.001 It can be considered that the difference between the three groups is statistically significant,and further comparison between two groups can be made.There was a statistical difference between group A and group B(p<0.001).Compared between group A and group C(P <0.001)was statistical significance.Comparison between group B and group C(P <0.001)was statistically significant.4?Comparison of functional scores of reconstructed fingers in three groups of patients,group A 12.83 ± 0.86,group B 10.27 ± 0.83,group C 12.28 ± 0.96.The data of the three groups belong to normal distribution data,the variance is equal,F = 41.75 P <0.001,can be considered The differences between the three groups are statistically significant and can be further compared in pairs.There was a statistical difference between group A and group B(p <0.001).Comparison between group A and group C(P = 0.065 > 0.05)was not statistically significant.Comparison between group B and group C(P <0.001)was statistically significant..5?Comparison of the shape score of the reconstructed thumb of the three groups of patients,group A 33.50 ± 1.76,group B 33.83 ± 1.92,group C17.22 ± 3.75.The data of the three groups belong to normal distribution data,the variance is equal,F = 233.751 P <0.001,can be considered The differences between the three groups are statistically significant and can be further compared in pairs.There was no statistical difference between group A and group B(p = 0.706> 0.05).Compared between group A and group C(P <0.001)was statistical significance.Comparison between group B and group C(P <0.001)was statistically significant..6.Among the three groups of patients,1 patient in group A had infection,1 had flap arterial crisis after surgery,and 1 had flap edge necrosis;2 patients in group B had arterial crisis and 1 Skin flap necrosis occurred in 2 cases;no infection,hematoma,or flap necrosis occurred in group C patients.Pairwise comparisons were made using Fisher's exact probability method.Comparison between group A and group B(P = 1> 0.05)was not statistically significant.There was no significant difference between group A and group C(P = 0.229> 0.05).There was no significant difference between group B and group C(P = 0.229> 0.05).7.Comparison of American Orthopedic Foot and Ankle Society(AOFAS)for hallux metatarsophalangeal-interphalangeal scores in the three groups of patients,group A 71.17 ± 4.62,group B 85.83 ± 3.70,group C70.89 ± 5.30.The data of the three groups belong to normal distribution data,the variance is equal,F = 62.543 P <0.001,it can be considered that the difference between the three groups is statistically significant,and can be further compared in pairs.There was a statistical difference between group A and group B(p <0.001).There was no significant difference between group A and group C(P = 0.86> 0.05).Comparison between group B and group C(P <0.001)was statistically significant.Conclusion: 1?The wrap-around flap combined with the second toe joint tendon system or the combined iliac bone graft reconstruction can restore good appearance of thumb ? and ? degree defects,and the wrap-around flap combined with the second toe joint tendon system can recover better function than the wrap-around flap combined with the iliac bone.2?Reconstruction of the second toe with free transplantation for repairing thumb ? and ? degree defects is easy to operate and requires less time for surgery.It is suitable for patients who have lower requirements on the shape or are unwilling to take a greater risk of surgery.3?The method of combining the wrap-around flap with the iliac bone to reconstruct the thumb is less harmful to the donor site. |
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