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[Upper limb free flap for repair of severe contracture of thumb web and one stage reconstruction of index finger abduction].

OBJECTIVE
To evaluate the effectiveness of the upper limb free flap for repair of severe contracture of thumb web, and one stage reconstruction of the index finger abduction.


METHODS
Between March 2007 and June 2011, 16 cases of severe contracture of thumb web and index finger abduction dysfunction were treated. There were 14 males and 2 females with an average age of 29 years (range, 16-42 years). All injuries were caused by machine crush. The time between injury and admission was 6-24 months (mean, 10 months). The angle of thumb web was 10-25 degrees (mean, 20 degrees), and the width of thumb web was 15-24 mm (mean, 22 mm). After scar relax of the thumb web, the defect size ranged from 6 cm x 4 cm to 8 cm x 6 cm; the upper limb free flap from 7 cm x 5 cm to 9 cm x 7 cm was used to repair the defect, index finger abduction was simultaneously reconstructed by extensor indicis proprius tendon transfer. The donor site was repaired with skin grafting.


RESULTS
All the flaps and skin graftings survived after operation and incisions healed by first intention. Fourteen patients were followed up 6-12 months (mean, 9 months). The flap appearance was satisfactory. The two-point discrimination was 6-9 mm (mean, 7 mm) after 6 months. The angle of thumb web was 85-90 degrees (mean, 88 degrees). The width of thumb web was 34-52 mm (mean, 40 mm). The abduction and opposing functions of thumb and abduction function of index finger were both recovered.


CONCLUSION
A combination of the upper limb free flap for severe contracture of thumb web and one stage reconstruction of the index finger abduction for index finger abduction dysfunction can achieve good results in function and appearance.