Ramesh, B A (2008) Study of Neurovascular Island Flap or Resurfacing Thumb Defects. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Sensibility is essential to the normal function of the hand; in the thumb it is particularly important because each hand has only one thumb. If sensibility is lost, it can be said that the function of the hand is so impaired that it is as though the hand is “blind”. Since the original work by Moberg (1964) on the sensory function of the fingers, many studies have reported on the treatment of nerve injuries and the evaluation of the sensory function. Dellon (1981) and Wynn Parry and Salter (1976) have aroused the attention of surgeons by reporting that special techniques of sensory re-education can result in improved sensation. However, it remains very difficult to measure sensation in a way which is quantitative, reasonably quick and easy to do, and which is related to function of the hand in real life. AIM OF STUDY: To identify outcome of Neurovascular island flap in our series with reference to: • Etiology, • Age distribution, • Sex distribution, • Anatomical variation, • Procedure and modification to improve the result, • Sensory reorientation in our population and method of improvement, • Two point discrimination in our population and method of improvement, • Donor site disability, • Return of work. MATERIALS AND METHODS: Forty two patients were operated. Two patients were females and the rest were males. The age of the patients ranged from nine to fifty-five years. Except for the three young patients aged less than 18 years all were industrial injuries. Of these three patients two had accidental electrical injury to thumb terminal phalanx and the other sustained accidental injury with knife. All patients were right handed. Sixteen patients were operated on nondominant hand (i.e. Left hand). Eight patients underwent osteoplastic reconstruction and the rest of the cases were operated for soft tissue loss on thumb. The follow-up period was for every 6 months for all patient for 2 years. RESULTS: Functional improvement was obtained in all 42 patients. The flap transfers provided a blood supply, durable skin cover and protective sensibility. This was reflected in all patients by the colour and texture of their thumbs, and confirmed by the fact that all 42 patients returned to pre injury work. From a clinical point of view the results presented are encouraging, as two-point discrimination was less than 15mm and consistently same in follow up. Experience has shown that useful tactile gnosis is correlated to the finding of 2 PD < 15 millimeters (Moberg 1966), a fact that was reflected in the performance of the pick-up test. The two point discrimination improved to near normal when dorsal branch of digital nerve was transected and sutured to thumb digital nerve(Lee PRS Oct 2006). Increase in 2 PD could be due to factors such as fibrosis from the scar tissue or repetitive minor trauma to the palm with subsequent pedicle compression must have played a part. Sensory reorientation is better after one year of surgery and dominant hands have complete sensory reorientation. Experience has shown that sensibility can be improved by prolonged exercises, such as with the blind learning Braille, and after nerve injury (Dellon, Curtis and Edgerton 1971). Most of the patients in this study returned to work in two months time and actively used their thumb which could be the reason for early sensory reorientation. The dominant hand had good sensory reorientation as this being the hand more frequently used (Krag.C 1975). Differences in sensory reorientation between flap taken from mid and ring finger could not be tested in this study as ring finger flaps were done only in last 6 months. CONCLUSION: • Most common cause is industrial accident • Most commonly involved in the age group between 20 to 40 yrs. • Males most commonly injured.(M:F=40:2) • Right thumb was commonly injured.(R:L=26:16) • Donor finger contracture was avoided by proper post operative splinting. • Preservation of dorsal branch of digital nerve retains sensation at finger tip in the ipsilateral side of donor finger. • Cold intolerance was not seen in any of our patients because of warm climate. • Two point discrimination over the transferred flap is less than 15mm which is necessary for manual work. (Moberg, 1966). • Two point discrimination improved if flap was taken as distally as possible. • Good sensory reorientation was achieved one year after surgery. • Dominant hand regains good sensory reorientation. • If dorsal branch of digital nerve was transected and repaired to thumb digital nerve, sensory reorientation was better and two point discrimination was improved. This is useful when the patient is skilled professional like software engineer, musician. • Appearance of donor finger is acceptable for our patients.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Neurovascular Island Flap ; Resurfacing Thumb Defects. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:49 |
| Last Modified: | 12 Oct 2017 01:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3507 |
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