Vishnu Babu, G (2013) A comparative study to assess the functional and aesthetic outcome of single stage reconstruction with staged osteoplastic reconstruction of thumb: A Retrospective and Prospective study. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION The presence of an opposable thumb has provided man with unique functional capability. Daily tasks involving pinch, grasp, grip and precision handling are more easily accomplished with an opposable thumb. Congenital absence or hypoplasia, traumatic loss diminishes or eliminates the thumbs prehensile abilities and may affect overall hand function. The loss of the thumb alters the aesthetic symmetry of the hand and can result in up to 40% impairment of hand function. Hence significant interest has been developed all over the world, during the years in the development of various methods of thumb reconstruction. Various methods have evolved over the years; the following methods have emerged as the preferred ones: 1. Osteoplastic reconstruction of thumb using skin cover, bone graft and a digital neurovascular island flap. 2. Single stage reconstruction of thumb using available local and regional flaps, bone graft and a digital neurovascular island flap. 3. Pollicization of index finger. 4. Microsurgical reconstruction using great toe or second toe. Hence management of patients with thumb loss requires sound clinical evaluation and judgment in regard to treatment plan and excellent surgical technique required to get good functional outcome of the hand. AIM OF THE STUDY: To compare the functional and aesthetic outcome of single stage thumb reconstruction with staged osteoplastic reconstruction of thumb. MATERIALS AND METHODS: This is a retrospective and prospective study done between the period of January 2011 to January 2013 at our institution. 16 patients were taken up for the study in each group and compared the functional and aesthetic outcome of each procedure. Functional assessment was done at 6 months in each group. Multiple surgeons were involved in reconstruction. Inclusion criteria : All patients with thumb loss distal to MP Joint who underwent single staged thumb reconstruction or osteoplastic reconstruction. Exclusion criteria: Patient not willing for single staged reconstruction underwent other methods of thumb reconstruction. RESULTS: Our study results are Patient underwent Single stage thumb reconstruction are consider as “GROUP A” where as patient underwent staged osteoplastic reconstruction are consider as “GROUP B”. In Group A –youngest age at reconstruction was 14 years and the oldest was 40 years. The average age at reconstruction was 26 years, where as in Group B- youngest age at reconstruction was 16 years and the oldest was 45 years. The average age at reconstruction was 28 years. In both group male and female, underwent reconstruction were in the ratio of 4: 1. In both group right side was commonly affected than left side. In both the group industrial accident was found to be the commonest cause of thumb loss. Other etiologies were Road Traffic Accident and assault. Group A average two point discrimination in the reconstructed thumb was 8mm and group B two point discrimination was 9mm. Group A average Kapandji’s opposition score was 7 and group B average kapandji’s opposition score was 6. In Group A none of the patient was developed thumb web contracture whereas in group B, 4 patients developed thumb web contracture. Group A patient average grip strength of the reconstructed thumb was 44 % where as in group B average grip strength of the reconstructed thumb was 39 %. Group A average tripod pinch strength recorded was 45 % whereas Group B average tripod pinch strength recorded was 40 %. Group A average key pinch strength recorded was 50 % whereas Group B average key pinch strength recorded was 46 %. Group A patient activity of daily living (ADL) using both hands-80 % whereas Group B patient activity of daily living (ADL) using both hands-78 % Group A patient activity of daily living (ADL) using reconstructed hand-73% whereas Group B patient activity of daily living (ADL) using reconstruction hand-71 %. Group A reconstructed thumb pain score was-12 % whereas Group B reconstructed thumb pain score was-13 %. Group A reconstructed thumb aesthetic score was-81 % whereas Group B reconstructed thumb aesthetic score was-74 %. Group A reconstructed thumb satisfaction score was-85 % whereas Group B reconstructed thumb satisfaction score was-76 %. CONCLUSION: The thumb contributes approximately 40% of hand function. Hence loss of thumb is considered a major disability. Several techniques areavailable to reconstruct the thumb following trauma and the method of reconstruction is based on the patient choice and surgical experience. Single stage thumb reconstruction using FDMA flap and N-V island flap, PIA flap and N-V island flap is simple, safe and versatile, particularly where microsurgical techniques are not available. This method of reconstruction replaces “LIKE FOR LIKE” tissue. In our study, we found that Single stage reconstruction using FDMA flap and N-V island flap (neurosensory flaps) are considered as the ideal method of reconstruction. Single stage reconstruction allows early mobilization of CMC joint and produces better functional outcome when compared to staged osteoplastic reconstruction. In our study, patients that underwent single stage thumb reconstruction with “LIKE TISSUE” replacement recovered with better grip strength and key pinch (both required for activites of daily living and work, specially in manual labourers) than patients who had staged thumb reconstruction. Single stage reconstruction fulfils all the criteria for an ideal reconstruction of thumb like stability, length, mobility, sensibility than staged reconstruction, especially FMDA flap in single stage reconstruction retains better sensation than groin flap in staged reconstruction. Single stage “LIKE TISSUE” thumb reconstruction patient had better aesthetic appearance than staged reconstruction using groin. Single stage reconstruction patients had high satisfaction regarding the appearance and the overall functional outcome of hand than staged reconstruction. The disadvantages common to both groups were due to the primary injury (loss of Nail-Nail bed complex and IP Joint). Patients are less satisfied with the aesthetic outcome in PIA flap forearm donor site (secondary defect).
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | comparative study ; functional and aesthetic outcome ; single stage reconstruction ; staged osteoplastic reconstruction of thumb ; retrospective and prospective study. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:50 |
| Last Modified: | 12 Oct 2017 01:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3512 |
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