OBJECTIVE: To summarize the application of cross-arm skin flaps with lateral antebranchial cutaneous nerve in repair of soft tissue defect. METHODS: From March 1996 to March 2001, 37 cases of soft tissue defect at fingertips were repaired by cross-arm skin flaps with lateral antebranchial cutaneous nerve, 1.5 cm x 1.5 cm to 3.5 cm x 4.0 cm in size. All of the cases were followed up for 3-48 months with routine evaluation of the wound and the function of hands. RESULTS: All of the flaps survived and the wound achieved primary healing. The sensation and shape of hands recovered well. CONCLUSION: It’s a good choice to repair soft tissue defect at fingertips by cross-arm skin flaps with lateral antebranchial cutaneous nerve.
Objective To observe the clinical effects of neurovascular island flap from the same finger for repairing pulp defect. Methods From November 2003 to February 2005, 32 pulp defects in 30 cases were covered with neurovascular island flap from the same finger.There were 25 males and 5 females. The age ranged from 18 to 56 years. The operation was performedafter debridement and 2-8 days antibiotics therapy. The defect area ranged from 1.5 cm×1.2 cm to 3.5 cm×2.1 cm. The flap was harvested on the dorsal part ofthe finger ularly or radially. The distal end of the flap should be more than 5mm away from the nail base to avoid nail injury. The ventral and dorsal cut should not exceed the middle line respectively. The flap size ranged from 2.0 cm×1.5 cm to4.0 cm×2.5 cm. The donor site was covered with flap of subdermal vascular plexus from the medial side of the upper arm. Results All 32 transferred flaps survived after operation. There was no vascular crisis. Twentyfive cases were followed up from 2 to 8 months. The flaps had good appearance and texture and blood circulation. Two-point discrimination was 7-10 mm. The function of finger motion was returned to normal. Conclusion Transfer of neurovascular island flap from the same finger offered a sensational skin flap for reconstruction of pulp defect. The technique was simple, andthe clinical result was satisfactory. It is an ideal method for reconstruction of thumb or finger pulp defects.
Objective To investigate the method and cl inical outcomes of repairing the skin and tissue defect of the finger pulp with transverse digital palmar island flap. Methods From August 2007 to September 2008, 9 patients with skin and tissue defects of the finger pulp were treated, including 6 males and 3 females aged 18-48 years old. The defect was caused bycrush injury by machine in 6 cases, pressure injury by heavy objects in 2 cases, and abrasion injury by grinding wheel in 1 case. The defect was located in the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 3 cases, the proximal phalanx in 1 case, the middle phalanx in 7 cases, and the distal phalanx in 1 case. The defect size ranged from 1.3 cm × 1.0 cm to 2.5 cm × 1.5 cm. The defect was compl icated with unilateral blood vessel and nerve defect in 8 cases, bone fracture in 2 cases, and tendon exposure in 5 cases. The time between injury and hospital admission was 20 minutes-14 hours. Transverse digital palmar island flaps (2.0 cm × 1.2 cm-4.0 cm × 1.7 cm) were used to repair the soft tissue defect during operation. The donor site was repaired with full-thickness skin graft. Results All the flaps and skin graft at the donor site survived uneventfully. All the wounds healed by first intention. Nine patients were followed up for 6-17 months. The appearance of the flaps was similar to that of the uninjured side, there was no occurrence of obvious pigmentation and scar contracture, and the two-point discrimination value was 8-11 mm. According to the function evaluation standard for the replantation of severed finger by Chinese Medical Association Hand Surgery Academy, 8 cases were graded as excellent, 1 as good. Conclusion Repairing the skin and tissue defects in the finger pulp of middle and distal phalanx with transverse digital palmar island flap can simpl ify the operation procedure, reduce the suffering of the patient, and provide satisfying therapeutic effect.
ObjectiveTo explore the effectiveness of the side island flap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects. MethodsBetween May 2008 and July 2012,36 cases of thumb pulp defects were treated with the side island flap coinciding dorsal branch of the digital nerve.There were 26 males and 10 females,aged 21-51 years (mean,32.4 years).The injury causes included electric saw injury in 14 cases,punch press injury in 8 cases,machine twist injury in 5 cases,door crushing injury in 5 cases,and glass cutting injury in 4 cases.The left hand was involved in 12 cases and the right hand in 24 cases.Combined injuries included tendon and bone exposure in all cases,fracture of the distal phalanx in 3 cases,and nail bed lacerations in 2 cases.The defect size ranged from 1.4 cm×1.2 cm to 2.5 cm×2.1 cm;and the flap size ranged from 1.8 cm×1.4 cm to 3.0 cm×2.5 cm. ResultsTwo flaps with distal skin flap tension blisters and skin scabbing,which were cured after dressing changes;the wound healed by first intension in the other 34 cases.The skin grafts at donor site survived,and primary healing of incision was obtained.The patients were followed up 3-15 months (mean,8 months).The appearance and function restored well.Two-point discrimination of the flap was 5.2 mm on average (range,4-8 mm) at last follow-up.The finger joint had no stiff.According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,the sensation was S4 in 33 and S3+ in 3 cases.No ectopic feeling was observed.The extension and flexion activity of fingers at donor site was normal,the sensation reached S4 with no atrophy of the finger. ConclusionWith constant anatomy,reliable blood supply,and safe operation,the anastomoses of the finger side island flap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also effectively overcome the ectopic feeling with traditional methods and protect feel function of the fingers at donor site.
Objective To investigate the surgical procedures and cl inical outcomes of the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect. Methods From February 2006 to May 2009, 11 cases (11 fingers) of finger pulp defect with tendon and bone exposure were treated, including 8 males and 3 females with an average age of 29 years (range, 23-40 years). The defect locations were thumb in 2 cases, index finger in 5 cases, and middle finger in 4 cases. The defect size ranged from 1.0 cm × 1.0 cm to 2.5 cm × 2.0 cm. The time frominjury to operation was 1-9 hours. The flap size ranged from 1.5 cm × 1.5 cm to 3.0 cm × 2.5 cm. Five flaps carried the dorsal branch of digital nerve, 6 flaps carried nervi digitales dorsales. The flaps were cut from proximal radial dorsal ring finger in 4 cases and from promximal ulnar dorsal ring finger in 7 cases. Defect of donor site was repaired with full-thickness skin grafting. Results All flaps and grafted skins survived; wound and incision of donor site achieved heal ing by first intention Eleven patients were followed up 6 to 24 months with an average of 12 months. The other finger flaps had good texture and shape except for 1 flap with sl ightly bloated. The activities of finger distal interphalangeal joint were normal, the two-point discrimination of finger pulp was 7-12 mm. The extension and flexion activities of donor fingers were normal, the ringl ike thread scar left at the donor site. Conclusion It is an ideal method to use the neurovascular free flap based on dorsal branch of digital artery of ring finger graft for repair of finger pulp defect, which has the advantages of simple operation, good appearance, and functional recovery.