文章發表：J Trauma Acute Care Surg. 2012 Mar;72(3):737-43.
大綱
一、背景：上肢創傷可能同時表現為軟組織和肌肉缺損，需要游離的皮瓣來進行修復。肢體的基本功能可以通過二次肌腱轉移或正常的肌肉轉移來恢復。功能正常的肌肉瓣可在單個過程中提供軟組織修復和功能恢復，但這種過程的成功需要進一步闡明。二、方法：從1997年到2006年，有9例患者因上肢複合結構和功能缺陷而進行了自由功能性肌肉轉移，包括四指前屈指深肌和三指前伸指肌缺損。七個拇指肌腱缺損可以同時進行肌腱和自由功能的肌肉轉移。此外，還進行了兩次對掌肌腱轉移術和一次拇指基底關節固定術，以進行拇指功能調整。三、結果：在所有九名患者中，手術均完成，無併發症，皮瓣得以存活，使患者能夠達到對掌的手功能。肌肉力量達到M4.2（M3-5）。與另一隻手相比，握力為41.7，捏力為55.3%。四、結論：最早的功能性肌肉轉移可以在開放性傷口中提供第一階段的複合功能恢復。拇指可經由肌腱轉移重建，然後進行對掌肌腱轉移術，以達到令人滿意的對掌功能。
BACKGROUND:
Upper limb trauma may present as both soft tissue and muscle defects necessitating a free skin flap to effect a repair. The limb's core (basic) functionality can be returned with a secondary tendon transfer or a functioning muscle transfer. A functioning muscle flap can provide for soft tissue repair and functional restoration in a single procedure, but the success of such procedures requires further clarification.
METHODS:
From 1997 to 2006, nine patients underwent free functioning muscle transfer performed for upper extremity composite structure and functional defects, including four flexor digitorum profundus muscle and three extensor digitorum comminis muscle defects. Seven thumb tendon defects were managed with simultaneous tendon and free functioning muscle transfer. In addition, two opponensplasties and one thumb basal joint arthrodesis were performed for thumb function revision.
RESULTS:
In all nine patients, procedures were completed without complications, the flaps surviving, enabling the patients to achieve opposable hand function. The muscle strength accomplished M4.2 (M3-5). The grip power was 41.7, and pinch power 55.3%, when compared with the other hand.
CONCLUSIONS:
Primary functioning muscle transfer can provide a one-stage composite functional restoration in an open wound. The thumb can be reconstructed with tendon transfer followed by opponensplasty to achieve a satisfactory range of opposable function.
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