미세수술을 이용한 무지의 재건 = Microsurgical Reconstruction of the Thumb

다국어 초록 (Multilingual Abstract)

Compared with non-microsurgical reconstruction of the thumb, microsurgical reconstruction can provide more desirable postoperative results regarding to the function as well as appearance. Toe transfer in one of its forms offers many of the best ways to reconstruct defects of the thumb. For reconstruction of the pulp, nail, and the first web space, microsurgical transfer of required tissues provides excellent sensory restoration leaving little morbidity at the foot. For composite defect of the partial thumb amputations, wrap-around procedure and trimmed great toe transfer is one of the best options in cosmesis. Trimmed great toe transfer technique is to circumvent the lack of motion of the wrap-around flap. In cases of loss of the entire thumb, preliminary procedure is inevitable to avoid foot morbidity.
After distant groin flap and autogenous bone graft, secondary toe-to-hand transfer is possible with great toe or second toe. Regarding to operation timing, preoperative planning is very important to induce rapport formation between patient and doctor. In case of malignant tumor resection, immediate reconstruction is much better than delayed reconstruction. Transfer of all parts of the great toe imparts some morbidity to the foot, but the effect when evaluated with gait studies is generally minimal. Certainly, the tradeoff of a thumb for the loss of the great toe is usually well-accepted by the patient. The primary disadvantage of these techniques is their inherent complexity and,although they offer superb reconstructive options in patients with loss of all or part of the thumb, their application should probably be limited to those practitioners with experience.

국문 초록 (Abstract)

목적: 무지에 발생한 다양한 결손에 대하여 미세수술을 이용한 재건수술의 적응증,수술 방법, 술 후 결과, 각 방법의 장단점과 합병증 등에 대해 살펴보고, 절단 위치와절단된 조직의 종류에 따라 가장 적합한 수술 방법을 찾아보고자 한다.
대상 및 방법: 지난 20년간, 무지에 발생한 외상, 선천성 기형, 악성 종양 절제술 후결손부의 재건을 시도한 경우 중에 미세수술을 이용한 무지재건술을 받은 환자를 대상으로 하였다. 무지의 부분 결손은 지절간 관절 원위부에 발생한 수질부, 조갑부, 원위지골을 포함한 복합조직 결손, 그리고 제1수지간부의 연부조직 결손으로 구분하여각각 가장 비슷한 성질을 가진 적합한 조직을 전이하여 재건하였다. 무지의 근위지골에서 절단된 경우에는 포장 주위 피판이나 다듬은 족무지 전이술이 적합하다. 중수지관절 근처에서 절단된 경우에는 중족골 골두에서 경사 절골술과 족저판 단축으로 과신전 관절을 굴곡 관절로 변환시켜 제2족지나 족무지를 전이하는 것이 좋다. 또한 중수골의 결손이 심한 경우에는 미리 골이식과 원거리 피판으로 연부조직을 보충한 후족무지 전이술을 하는 것이 공여부의 이환을 줄일 수 있다.
결과: 수술 성공률은 95% 이상으로 피판 생존 시 술 후 만족도는 비미세수술적 방법보다 기능이나 미용적인 면에서 우월하였다.
결론: 미세수술을 이용한 무지재건술을 시행할 때 수술의 실패는 공여부의 또 다른장애를 초래하므로 한정된 수술 적응증과 적합한 수술 시기의 선정이 중요하다. 재건될 무지는 반드시 미적으로 기능적으로 우수해야 하며, 술 후 발생할 수 있는 공여부와 수혜부의 합병증을 최대한 줄이도록 노력해야 한다.

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