Académique Documents
Professionnel Documents
Culture Documents
THUMB RECONSTRUCTION
Pembimbing
D r . B e t a S u b a k t i N , S P. B P - R E ( K )
1
“Loss of thumb function impairs the entire upper limb, and
carries a high priority for reconstruction”
2
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
Strong contraindications
• vascular disease
• short life expectancy, chronic pain with disuse of the limb
• unreconstructable sensory loss
• Unrealistic patient expectations
• other contraindications dictated by the common sense of the
surgeon.
3
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
EVALUATION
4
AS WITH ANY DIGITAL INJURY, INITIAL
EVALUATION INCLUDES AN ASSESSMENT OF
6
1. What is the status of the basal joint?
7
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
2. Is there a first web space contracture or skin deficit?
8
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
3. Are there problems with the remaining digits?
9
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
TYPES OF DEFICIENCIES
12
13
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
Reconstruction may be either
• emergency
• urgent
• subacute
• elective
14
As with any extremity injury,
reconstructive priorities are
• First HEALING
(blood supply, stable skeleton, mobile soft-tissue cover)
• and then FUNCTION
(nerve function, passive range of motion, active range of
motion).
15
COMPONENT LOSSES
16
• Skeletal injuries are managed by anatomic reduction and fixation.
17
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
“Reconstructing component loss requires
an appropriate flap.”
18
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
Innervated flaps
19
Noninnervated regional flaps
Posterior interosseous
Radial forearm
Intrinsic muscle flaps
22
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
23
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
A M P U TAT I O N
24
Amputation Distal to the Metacarpophalangeal Joint
25
Amputation Proximal to the Metacarpophalangeal Joint
26
28
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
ESTABLISHED THUMB RECONSTRUCTION
PROCEDURES
29
OSTEOPLASTIC THUMB RECONSTRUCTION
30
TECHNIQUE
31
TECHNIQUE
Donor-site variations
A variety of free tissue transfers including the excellent “wraparound” toe transfer
32
TECHNIQUE
33
PHALANGIZATION
34
TECHNIQUE
35
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
METACARPAL DISTRACTION LENGTHENING
36
TECHNIQUE
37
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
ON-TOP PLASTY
38
TECHNIQUE
Ray resection
Preoperative arteriography
39
40
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
41
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
POLLICIZATION
42
TECHNIQUE
• Pollicization refers to the neurovascular pedicle movement of a finger, often with its
metacarpal, for thumb reconstruction
• For congenital absence of the thumb, a simplified modification is recommended
• The index finger is basically recessed by resection of a segment of the second metacarpal
base, then pronated about 130 degrees and projected in palmar abduction at its fixed base.
43
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
TOE-TO-THUMB TRANSFERS
44
45
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
WRAPAROUND TOE TRANSFER
46
TECHNIQUE
47
Grabb and Smith's Plastic Surgery, Seventh Edition by Charles H. Thorne, 2014
REFERENCES
1. Littler JW. On making a thumb: one hundred years of surgical effort. J Hand Surg. 1976;1:35.
2. Goldner RD, Howson MP, Nunley JA, et al. One hundred eleven thumb amputations: replantation
vs. revision. Microsurgery. 1990;11:243.
3. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast
Reconstr Surg. 1986;78:285.
4. MorrisonWA, O’Brien BM,MacLeod AM. Thumb reconstruction with a free neurovascular wrap-
around flap from the big toe. J Hand Surg. 1980;5:575.
5. Buck-Gramcko D. Thumb reconstruction by digital transposition. Orthop Clin North Am.
1977;8:329.
6. Stern PJ, Lister GD. Pollicization after traumatic amputation of the thumb. Clin Orthop.
1981;155:85.
7. May JW, Bartlett SP. Great toe-to-hand free tissue transfer for thumb reconstruction. Hand Clin.
1985;1:271.
8. Lipton HA,May JW, Simon SR. Preoperative and postoperative gait analyses of patients
undergoing great toe-to-thumb transfer. J Hand Surg. 1987;12:66. Copyright ©
48
THANKS
49