通过显微外科自体移植足部组织复合物，分阶段修复儿童手部的4个手指

封面

如何引用文章

全文:

详细

论证。目前足趾显微外科自体移植仍然是修复出生后或外伤后缺失手指的最有前途和最实用的方法。 在需要修复2个或更多足趾的情况下，同时移植双脚的组织复合物（包括1个或2个足趾）是可能的，也是必要的。因此，在一次手术过程中最多可以重建手部的4个手指。根据文献记载，这种手术很少进行，因为手术非常耗费人力和时间。

目的。本研究旨在展示在先天性和后天性病变的儿童中，通过显微外科手术将4个足足趾自体移植到手部的经验成果。

材料和方法。通过临床、X线、生物力学等方法，对9例先天性和后天性上肢畸形患者进行一次显微外科自体移植，每足2个组织复合体累及Ⅱ~Ⅲ指的治疗结果进行评价。确定了对手部缺失四指（或全部五指）的儿童实施这种显微外科重建方法的适应症；分析了结果、术后并发症以及对供体和受体区域的评估。

结果。在修复显微外科和手外科进行的914例儿童手部足趾自体移植手术中， 9例进行了4个足趾 （每个脚两个）的单阶段移植。患者的平均年龄为4.2岁。两名患儿的手部有先天性畸形，7名患儿的手部有外伤。8例手部II~V指修复,1例手部I~IV指修复。22%的移植物出现了与循环障碍相关的并发症，但这些并发症都是暂时的。所有移植的移植物都存活了下来。所有患者在手指移植后都需要继续接受手术治疗，以改善外观和功能。生物力学检查方法显示，他们在术后平均4个月（±1个月）就完全恢复了功能。

结论。这项研究表明，对于患有先天性和后天性手部病变的儿童，在需要恢复4个足趾时，使用这种手术的可能性和有效性都很高。一次显微外科足趾移植手术可恢复手部的良好外观和功能。

作者简介

Sergey I. Golyana

Turner Scientific Research Institute for Children’s Orthopedics

编辑信件的主要联系方式.
Email: ser.golyana@yandex.ru
ORCID iD: 0000-0003-1319-8979
SPIN 代码: 8360-8078

Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

参考

  1. Shvedovchenko IV, Kol’tsov AA. Peresadka pal’tsev stopy na kist’ u detei s vrozhdennoi i priobretennoi patologiei — osnovnye problemy i puti ikh resheniya. Annaly plasticheskoi, rekonstruktivnoi i ehsteticheskoi khirurgii. 2017;(1):143. (In Russ.)
  2. Golyana SI, Avdeychik NV, Grankin DY, Safonov AV. Microsurgical toe-to-hand transfer in children. Modern Problems of Science and Education. Surgery. 2019;(6):150. (In Russ.) doi: 10.17513/spno.29371
  3. Jones NF, Clune JE. Thumb amputations in children: classification and reconstruction by microsurgical toe transfers. J Hand Surg Am. 2019;44(6):519.e1–519.e10. doi: 10.1016/j.jhsa.2018.08.013
  4. Avdeychik NV, Golyana SI, Grankin DY, et al. Possibilities of using microsurgical autotransplantation of tissue complexes in children. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2020;8(4):437–450. (In Russ.) doi: 10.17816/PTORS17896
  5. Nagrath N, Duggan E, Thurley N, Rodrigues JN. A Systematic review of the outcomes of microsurgical toe transfer for metacarpal and metacarpal-like hand deformity. J Hand Surg Asian Pac. 2022;27(1):32–42. doi: 10.1142/S2424835522500199
  6. Chi Z, Song DJ, Tian L, et al. Reconstruction of combined thumb amputation at the metacarpal base level and index amputation at the metacarpal level with pollicization and bilateral double toe composite transfer. J Plast Reconstr Aesthet Surg. 2017;70(8):1009–1016. doi: 10.1016/j.bjps.2017.05.032
  7. Tikhonenko TI, Golyana SI, Sokolova NE, et al. Evaluation criteria microcirculatory complications and anticoagulant therapy in microsurgical operations. Modern Problems of Science and Education. Surgery. 2020;(6):143. (In Russ.) doi: 10.17513/spno.30328
  8. Golyana SI, Tikhonenko TI, Govorov AV, et al. Complications after toe-to-hand transfers in children with pathologies of the hand. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2017;5(4):16–23. (In Russ.) doi: 10.17816/PTORS5416-23
  9. Minasov BSh, Garapov IZ, Biktasheva EM, et al. Results of the second toe autotransplantation for thumb reconstruction. Genij Ortopedii. 2022;28(1):34–38. (In Russ.) doi: 10.18019/1028-4427-2022-28-1-34-38
  10. Nikkhah D, Martin N, Pickford M. Paediatric toe-to-hand transfer: an assessment of outcomes from a single unit. J Hand Surg Eur. 2016;41(3):281–294. doi: 10.1177/1753193415594480.
  11. Belousov AE. Plasticheskaya rekonstruktivnaya i ehsteticheskaya khirurgiya. Saint Petersburg: Gippokrat, 1998. 744 p. (In Russ.)
  12. Buncke H Jr, Schulz WP. Experimental digital amputation and reimplantation. Plast Reconstr Surg. 1965;36(1):62–70. doi: 10.1097/00006534-196507000-00009
  13. O’Braien B. Mikrososudistaya vosstanovitel’naya khirurgiya. Transl. from eng. Moscow: Meditsina, 1981. 422 p. (In Russ.)
  14. Yoon AP, Jones NF. Long-term outcomes after toe-to-thumb transfers for burn reconstruction in children. J Burn Care Res. 2022;43(2):440–444. doi: 10.1093/jbcr/irab101.
  15. Wei FC, Al Deek NF. The battle ground between two giants: Toe transfer and hand allotransplantation. J Reconstr Microsurg. 2018;34(9):678–680. doi: 10.1055/s-0038-1639513
  16. Nakanishi A, Kawamura K, Omokawa S, et al. Quality of life in patients with toe-to-hand transplantation. J Plast Surg Hand Surg. 2018;52(6):359–362. doi: 10.1080/2000656X.2018.1520123
  17. Chen H, Jiang C, Xu Y, Sun Y. Toe-to-finger combined with free flap transfer for primary one-stage post-traumatic reconstruction of the complex fingerless hand. J Plast Reconstr Aesthet Surg. 2017;70(12):1708–1714. doi: 10.1016/j.bjps.2017.07.013
  18. Julve GG, Villén GM. The multiple monoblock toe-to-hand transfer in digital reconstruction. A report of ten cases. J Hand Surg. 2004;29(3):220–227. doi: 10.1016/j.jhsb.2003.11.003
  19. Jones NF, Graham D, Au K. Bilateral metacarpal hands: Reconstruction with 6 toe transfers. Hand (NY). 2020;15(4):465–471. doi: 10.1177/1558944718810844
  20. Al Deek NF, Lin Y-T, Wei F-C. Metacarpal-like and metacarpal hand. Hand Clin. 2016;32(4):549–554. doi: 10.1016/j.hcl.2016.06.004
  21. Wei FC, Al Deek NF, Lin YT, et al. Metacarpal-like hand: classification and treatment guidelines for microsurgical reconstruction with toe transplantation. Plast Reconstr Surg. 2018;141(1):128–135. doi: 10.1097/PRS.0000000000003940
  22. Ozols D, Zarins J, Petersons A. Novel technique for toe-to-hand transplantation: the fourth-toe as an alternative option for toe-to-hand transplantation for pediatric patients. Tech Hand Up Extrem Surg. 2019;23(2):74–80. doi: 10.1097/BTH.0000000000000234

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Photo (a, b) and X-ray (c) images of the child’s right hand during hospitalization at the Turner Scientific Research Institute for Children’s Orthopedics (before the start of surgical treatment) (RUS)

下载 (143KB)
索引源数据
3. Fig. 2. Appearance immediately after transplanting the toes from both feet into the position of fingers II–V of the right hand (RUS)

下载 (272KB)
索引源数据
4. Fig. 3. Photo of the hands after the completion of multistage surgical treatment (RUS)

下载 (60KB)
索引源数据
5. Fig. 4. Functional result of the hand after the restoration of four fingers: a — ability to bend the restored fingers into a fist; b, c — gripping capabilities of the right hand (RUS)

下载 (143KB)
索引源数据
6. Fig. 5. Patient’s manual skills (RUS)

下载 (357KB)
索引源数据
7. Fig. 6. One of the girls’ hobbies is modeling figures from plasticine (RUS)

下载 (228KB)
索引源数据
8. Fig. 7. Child playing sports

下载 (204KB)
索引源数据
9. Fig. 8. Condition of the right hand of a 3-year-old child with a complication of injury: a — view of the hand from the dorsal surface; b — view from the palmar surface; c — schematic of the hand before surgery (RUS)

下载 (175KB)
索引源数据
10. Fig. 9. Marking of incisions on the hand during surgical treatment: a — view of the marking from the dorsal surface; b — view from the palmar surface (RUS)

下载 (138KB)
索引源数据
11. Fig. 10. Stages of mobilization of toe II–III block autograft of the left foot with simultaneous separation of toes II and III on a common vascular pedicle: a — appearance of the feet before surgery; b — isolated (vascular) pedicle of toe II–III block autograft; c — toes II and III of the left foot after their separation (RUS)

下载 (213KB)
索引源数据
12. Fig. 11. Schemes of the step-by-step separation of toes II and III of the left foot into two autografts with a common vascular pedicle: a — scheme of the incisions on the foot; b — scheme of the incisions between toes II–III of the autograft block; c, scheme of the arterial source of autograft block (1 — dorsal artery of the foot; 2 — dorsal metatarsal artery; 3 — first plantar metatarsal artery; 4, second plantar metatarsal artery; 5 — third plantar metatarsal artery; 6 — fragment of the plantar arterial arch); d — scheme of the stage of the second plantar metatarsal artery branch intersection, namely, digital artery of finger II (7 — place of intersection); e — scheme of the separation of the autograft-block’s toes (1 — dorsal artery of the foot; 2 — dorsal metatarsal artery; 3 — first plantar metatarsal artery; 4, second plantar metatarsal artery; 5 — third plantar metatarsal artery; 6 — fragment plantar arterial arch; 8 — site of ligation (coagulation) of the digital artery of toe II); f — scheme of the venous source of the autograft block of toes II–III (9 — great saphenous vein of the foot; 10 — branches of the great saphenous vein to the toes of the autograft block); g — scheme of the separation of the autograft block’s veins (11 — site of ligation of the venous branches between toes II–III) (RUS)

下载 (508KB)
索引源数据
13. Fig. 12. Appearance of the hand immediately after the restoration of fingers I–IV of the right hand in a 3-year-old child, with complications of injury, using autotransplantation of two finger II–III autograft blocks of both feet with simultaneous separation of the toes in one autograft: a — view from the hand dorsum; b — view from palmar surface of the hand; c — view from the radial surface of the hand; d, scheme of the autograft location on the hand; e — scheme of the location and anastomosis of the autograft’s arteries (1 — dorsal foot artery; 2 — dorsal metatarsal artery; 3 — first plantar metatarsal artery; 4 — second plantar metatarsal artery; 5 — third plantar metatarsal artery; 6 — fragment of the plantar arterial arch; 12 — proximal fragment of the dissected radial artery; 13 — distal fragment of the dissected radial artery) (RUS)

下载 (436KB)
索引源数据
14. Fig. 13. Plantogram of the feet of a 4-year-old patient: 1 year after the operation of bilateral taking of toe II–III block. (Despite noticeable changes in the imprint’s anatomical shape of the operated feet, no difference was found in the width of their anterior parts. Foot function was not impaired, and the load distribution on both feet was even) (RUS)

下载 (94KB)
索引源数据
15. Fig. 14. Computer statokinesiogram of the patient after toe-to-hand transfer from the right foot. Reducing the eccentricity of the center-of-pressure (CoP) deviation from an ellipse with open eyes to a circle with closed eyes. Left: projection of the child’s real CoP relative to the average normative position of the CoP; right, graphical representation of the real statokinessiogram

下载 (186KB)
索引源数据
##common.cookie##