Skin Tube Bone Graft Thumb Reconstruction

Reconstruction of the skin and bone graft has been rarely used clinically. Because of its simple operation and easy success, it is an optional method when patients are not willing to choose other complicated reconstructive surgery. The disadvantage is that the shape is bloated, the feeling and circulation are poor, and there is no joint activity, so the function is poor. Treating diseases: thumb reconstruction Indication The reconstruction of the skin tube and bone thumb is suitable for the IV to V1 thumb defect in the first metacarpal and the tiger's mouth with skin scar contracture. Contraindications 1. Soft tissue of the thumb stump and deep tissue infection. 2. Those who have bleeding tendency and organic disease. 3. Adolescents with a defect above V2. Preoperative preparation 1. X-ray film to understand the first metacarpal defect. 2. Prepare the skin on the upper limbs and one side of the ankle and cut off the nails. Prepare the skin on the inside of the contralateral upper arm, the subclavian region, or the upper abdomen. Surgical procedure 1. Make an incision along the ankle, the length of which depends on the length of the humerus. Cut the skin, subcutaneous tissue and periosteum, and make appropriate peeling along the periosteum of the humerus outer plate. The gauze is packed and pressed to stop bleeding. According to the defect of the metacarpal bone and the length of the reconstructed thumb, the flat bone chisel was used to cut a strip of bone with a thickness of 1 cm and a slight curvature along the lateral bone plate. After hemostasis, the incision was sutured in layers, and the bone pieces were wrapped with wet gauze for use. 2. Remove the scar of the thumb stump and the scar of the tiger's mouth, reveal the stump of the first metacarpal and loosen the adhesion with the surrounding, so that the first metacarpal can fully extend. 3. The tibial block is trimmed according to the length of the reconstructed thumb, so that the curved convex surface faces the dorsal side of the ankle, and the 1 mm Kirschner wire is used for the longitudinal fixation with the first metacarpal. 4. Under the contralateral clavicle (in the subclavian region as an example), the flap is designed according to the circumference and length of the reconstructed thumb. The skin and subcutaneous tissue are cut to the deep fascia, and the flap is lifted and moderately thinned. Sewed into a leather tube, the Piti part of the wound is stitched with a pair of sutures to eliminate the wound. 5. The elbow joint is flexed, the upper arm is adducted, the bone graft is inserted into the skin tube, and the skin tube end is sutured with the skin of the thumb stump to fix the limb. 6. 2 weeks after the operation, the line was dissected and the tube was broken. According to the training situation, after the blood supply of the pedicle was completely blocked for 1 hour, the skin tube still had normal blood circulation. It was proved that the cutaneous branch was established with the proximal end of the cutaneous tube, the cutaneous pedicle was feasible, and the stump was sutured. 7. In order to make the thumb feel better, the island flap with vascular nerve bundle can be designed from the ipsilateral middle finger or the ulnar side of the ring to establish the feeling of the thumb stump. complication 1. If the bone graft is long, the distal end is easily hardened. 2. If the hemostasis is not complete during the formation of the skin tube, it is easy to cause bleeding inside the skin tube and affect the blood supply. 3. Reconstruction means that the feeling and circulation are poor, cold, and easy to frostbite and burn.