マイクロサージャリーによる手の先天異常再建術の経験

抄録

Four children with congenital malformation of the hand were treated successfully using microsurgical reconstructive procedures. Two children had hypoplastic thumbs (Blauth grade III), which were treated by dorso-volarly reversed vascularized second toe MP joint transfers for reconstruction of the missing first CM joints. They also had secondary tendon transfers for thumb opposition, extension and abduction. The results were cosmetically superior with five digits and favorable thumb growth. Function was also satisfactory.
One child with radial club hand (total aplasia of the radius) was treated using a vascularized second metatarsal head transfer as the bifurcation procedure with excellent results achieved. The wrist was supported by the grafted bone to repair the adduction instability, while maintaining the flexion-extension range of motion.
The last child with syndactyly of the middle and ring fingers had a vascularized dorsalis pedis flap at the site of the separation. The skin was durable enabling two correction osteotomies. However recently, a tissue expander is available for pure skin defect reconstruction. We concluded that microsurgical reconstruction is advantageous for repairing congenital malformation of the hand, especially hypoplastic thumb and radial club hand.