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Handchir Mikrochir Plast Chir 2023; 55(05): 336-343
DOI: 10.1055/a-2013-5449
Übersichtsarbeit

Die Behandlung der kontrakten ersten Kommissur der Hand: Literaturübersicht und eigene Erfahrungen

Treatment of the contracted first Commissure of the Hand: Literature Overview and own Experiences
Elmar Fritsche
1   Klinik für Hand- und Plastische Chirurgie, Luzerner Kantonsspital, Luzern, Switzerland
,
Dorrit Winterholer
1   Klinik für Hand- und Plastische Chirurgie, Luzerner Kantonsspital, Luzern, Switzerland
,
Urs Hug
1   Klinik für Hand- und Plastische Chirurgie, Luzerner Kantonsspital, Luzern, Switzerland
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Zusammenfassung

Der frei bewegliche Daumen ist für die Funktion der menschlichen Hand von zentraler Bedeutung. Diese Beweglichkeit ist an eine ungestörte Funktion der Kommissur zwischen dem Daumen und dem Zeigefinger oder bei Fehlen des Zeigefingers dem Mittelfinger gekoppelt. Eine erhebliche, durch welche Genese auch immer bedingte Kontraktur der ersten Kommissur hat unweigerlich einen erheblichen Funktionsverlust bis hin zur nahezu vollständigen Gebrauchsunfähigkeit des Daumens, ja der Hand zur Folge. Bei der operativen Behandlung der Kontraktur der ersten Kommissur ist häufig ein Eingriff an der kontrakten Haut ausreichend. In einigen Fällen bedingt sie aber ein mehrstufiges Vorgehen an Faszien, Muskeln und Gelenken, an dessen Ende die Weichteilerweiterung des Interspatiums zwischen Daumen und Zeigefinger steht. Wir erwähnen alte Einsichten zum Thema, geben einen Überblick über die Literatur, stellen eigene Erfahrungen anhand von 5 Fällen vor und geben – der Schwere der Kontraktur entsprechend – eine Therapieempfehlung ab.

Abstract

The freely movable thumb is of central importance for the function of the human hand. This mobility is necessarily linked to an undisturbed function of the commissure between the thumb and the index finger or, if the index finger is missing, the middle finger. A significant contracture of the first commissure, caused by whatever genesis, inevitably results in a significant loss of function up to almost complete inability to use. The surgical treatment of the first commissure often only affects the contracted skin. In some cases, however, it requires a multi-stage approach to fascia, muscles and joints, at the end of which there is the soft tissue expansion of the interspatium between the thumb and index finger. We mention old insights on the subject, give an overview of the literature, present our own experiences based on 5 cases and – according to the severity of the contracture – make a therapy recommendation.

Schlüsselwörter

Kontrakte erste Kommissur - eingeschränkte Daumenfunktion - Kommissurenplastik

Key words

Contracted first web - restricted thumb function - commissurplasty


Publikationsverlauf

Eingereicht: 07. Dezember 2022

Angenommen: 29. Dezember 2022

Artikel online veröffentlicht:
27. März 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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