Patients receiving venous skin grafts having 3 different patterns of nutrient supply were introduced. It was considered that the venous skin graft had contain role in the repair of skin defects of fingers and dorsum of hands. The mechanism of the survival of the venous skin graft was discussed. It was assumed that, in the early stage, the skin nutrient was possibly in relation with the effusion or exudation from the wound surface, and in the later stage, depended upon the collateral circulation established with the surrounding tissues.
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 evaluate the function of injured hand after repair of finger stump and reconstruction of digit tendon attachment in finger amputation. METHODS: From 1992 to 1998, 20 cases with amputation of the 2nd to the 5th fingers were investigated, of which reconstruction of digit tendon attachment in 10 cases (group A) and routine operation without reconstruction of digit tendon attachment in other 10 cases (group B). After 6 months of operation, the tension test, fatigue test the sense of stability in motion and the perimeter of forearm in injured hand and the corresponding healthy hand were compared. RESULTS: The differences were remarkable (P lt; 0.01) between group A and group B in the tension test of injured finger, the fatigue test, the sense of stability in motion and the perimeter of injured arm. CONCLUSION: The digit of injured finger should be reconstructed in finger amputation in order to furthest maintain the function of injured hand.
Objective To discuss the effectiveness of free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers. Methods Between May 2010 and September 2015, 28 patients with dorsal soft tissue defect of fingers were treated, including 17 males and 11 females with an average age of 23.8 years (range, 15-55 years). The reasons of injuries were machine twist (15 cases), heavy pound (4 cases), the sharp cut (5 cases), and hot crush (4 cases). The time from injury to admission was 30 minutes to 12 hours (mean, 1.5 hours). The involved fingers included thumb (3 cases), index finger (8 cases), middle finger (6 cases), ring finger (6 cases), and little finger (5 cases). The area of soft?tissue?defects ranged from 2.0 cm×1.5 cm to 3.5 cm×2.5 cm, and the area of free toe fibular-dorsal artery flap ranged from 2.8 cm×1.7 cm to 3.8 cm×2.8 cm. The blood supply of the flaps were reconstructed by anastomosing the toe fibular-dorsal artery, vein, and nerve to the dorsal digital artery, vein, and nerve, respectively. The donor site was repaired by free skin graft. Results The operation time was 1.5-5.5 hours (mean, 2.5 hours); the blood loss during operation was 10-50 mL (mean, 30 mL). Vessel?crisis?occurred?in?1 case, and the flap survived after symptomatic treatment. The other flaps survived and the wounds healed with stage I; the skin grafts at donor site survived and the incisions healed with stage Ⅰ. Twenty-eight cases were followed up 6-24 months (mean, 8 months). The appearance of flaps was good, and two-point discrimination was 3.5-12.0 mm (mean, 5.3 mm) at 6 months after operation. The fingers function of grab and pinch recovered. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 20 cases and good in 8 cases, with an excellent and good rate of 100% at 6 months after operation. The donor sites of toe were smooth and had no depression. The patients had normal gait. Conclusion Free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers can obtain satisfactory effectiveness in appearance and function of fingers, and has the advantages of modified repair and less injury at donor site.
Objective To investigate the operative procedure and the cl inical results of the modified island flap based on the reversed dorsal metacarpal artery for repairing finger tissue defect. Methods From January 2004 to March 2009, 38 patients (43 fingers) with finger tissue defect were treated with the modified island flaps based on the reversed dorsal metacarpal artery. The deverting point was altered from the dorsal point to the palm. There were 27 males (31 fingers) and 11 females (12 fingers) with an average age of 43.6 years (range, 12-67 years). Defect was caused by crash injury in 18 cases, crush injury in 14 cases, and cutting injury in 6 cases. Of them, 11 index fingers, 23 middle fingers, 7 ring fingers, and 2 l ittle fingers were involved. The area of the defect ranged from 1.0 cm × 0.7 cm to 3.2 cm × 2.5 cm. The area of flaps ranged from 1.2 cm × 1.0 cm to 3.5 cm × 2.8 cm. The donor sites were sutured directly. Results Tension vesicular scabbing occurred in distal part of flap, and was cured after dressing change in 3 cases. The other flaps survived and incision healed primarily. All incision at donor sites healed primarily. Thirty-one patients (35 fingers) were followed up 6-29 months (15.3 months on average). All flaps survived with satisfactory appearance, sensation, and function. Two-point discrimination was 6-9 mm (7.9 mm on average). The results were excellent in 20 fingers, good in 13 fingers, and fair in 2 fingers according to the total active movement (TAM) standards; the excellent and good rate was 94.3%. Conclusion The treatment of finger tissue defect with the modified island flap based on the reversed dorsal metacarpal artery is recommendable. The deverting point was altered from the dorsal point to the palm. The vessel pedicle is extended. It can be easily and conveniently performed for more cases.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
Objective To investigate the effectiveness of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Methods Between February 2013 and July 2016, 11 cases (11 fingers) of mid-phalanx degloving injury with distal segment finger defect were treated. There were 9 males and 2 females with an average age of 33.6 years (range, 18-59 years). The injury caused by twisting in 8 cases and crushing in 3 cases. The injury located at index finger in 3 cases, middle finger in 6 cases, and ring finger in 2 cases. The skin avulsion was from proximal interphalangeal joint in 1 case, proximal 1/4 of mid-phalanx in 6 cases, and 1/2 of mid-phalanx in 4 cases. The area of wounds ranged from 4.0 cm×1.7 cm to 6.2 cm×2.6 cm. The interval between injury and operation was 2.5-6.0 hours (mean, 4.5 hours). All defects were repaired with the ipsilateral digital proper artery dorsal branch flaps. The size of flaps ranged from 4.4 cm×1.9 cm to 7.0 cm×2.9 cm. Nerve anastomose was carried between digital proper nerve dorsal branch in the flap and digital proper nerve stump in the wound. The donor sites were repaired by skin grafting. Results Tension blisters of the flap and partial necrosis occurred in 1 case, and healed after dressing change. The other flaps and skin grafting survived, and wounds healed by first intention. All patients were followed up 6-18 months (mean, 16 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination of flaps ranged from 7 to 10 mm (mean, 8.5 mm). At last follow-up, according to the functional assessment criteria of upper limbs by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 10 cases and good in 1 case, with the excellent and good rate of 100%. Conclusion The ipsilateral digital proper artery dorsal branch flap is a good method to repair mid-phalanx degloving injury with distal segment finger defect for the advantages of simple operation, less damage in donor site, high survival rate of the flap, and good feeling recovery of the finger.
Objective To investigate the effectiveness of finger reconstruction using nail flap anastomosing the nerve branch of the first toe nail bed. MethodsBetween January 2016 and December 2022, 18 patients (18 fingers) with thumb or finger nail bed defects were admitted. There were 12 males and 6 females, with an average age of 32 years (range, 19-42 years). Four cases were finger tip tissue damage caused by machine compression, and 4 cases were distal tissue necrosis after finger replantation. There were 9 cases of thumb injury, 3 cases of index finger injury, 5 cases of middle finger injury, and 1 case of ring finger injury. There were 11 cases of distal nail damage and 7 cases of distal nail root (including nail root) damage. The time from injury to admission was 1-5 hours, with an average of 2 hours. After debridement and anti-infection treatment for 5-7 days, the wounds in size of 1 cm×1 cm to 4 cm×3 cm were reconstructed by using nail flaps anastomosing the nerve branches of the first toe nail bed. The size of the nail flaps ranged from 1.5 cm×1.5 cm to 4.5 cm×3.5 cm. The donor sites were repaired with the flaps in 16 cases and skin graft in 2 cases. Results All nail flaps, flaps, and skin grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months (mean, 10 months). The nails of 18 cases were all grown, in which 16 cases had smooth nails with satisfactory appearances, 1 case had uneven nails, and 1 case had obvious scar hyperplasia around the suture opening. At 6 months after operation, the two-point discrimination of the skin flap was 4-8 mm (mean, 6 mm). Meanwhile, the skin grafts and flaps at the donor sites regained protective sensation, good abrasion resistance, and had no negative effect upon walking and wearing shoes. ConclusionThe application of a nail flap that anastomoses the nerve branch of the first toe nail bed for finger reconstruction has minimal damage and can achieve good nail bed repair results.
Objective To investigate the operative method and cl inical efficacy of repairing fingertip defect with modified reverse homodigital artery island flap. Methods From March 2000 to September 2006, 18 cases (24 fingers) of fingertip defect were treated, including 12 males and 6 females aged 18-53 years (mean 29 years). Defect was caused by crush injuries in 12 cases, by avulsion injury in 3 cases, by twist injury in 2 cases and by incised injury in 1 case. The time from injury tooperation was 2-8 hours (mean 4 hours). The location were index fingers (3 fingers), middle fingers (4 fingers) and ring fingers (17 fingers). The defects of soft tissue were 1.9 cm × 1.7 cm to 2.4 cm × 1.9 cm in size, the reverse homodigital artery island flaps were from 2.0 cm × 1.5 cm to 2.5 cm × 2.0 cm in size. The donor site was repaired with dumped skin grafting(3 cases) and with skin grafting from medial area of planta pedis (15 cases). Results Skin flaps and skin grafting of all the 24 fingers survived after operation. All incisions and donor sites healed by first intention. Sixteen patients (22 fingers) were followed up for 1-5 years (mean 3.2 years).The appearance and function of the flaps were all satisfactory. Two-point discriminations of flaps ranged from 4.5 mm to 6.3 mm. According to the total active movement/total passive movement assessment criteria, the results were excellent in 20 fingers and good in 2 fingers; and the excellent and good rate was 100%. The circumference of donor site was 2.0-3.5 mm shorter than that of normal side. The two-point discriminations of donor site was 7.8-10.5 mm. Conclusion Repairing defect of fingertip with modified reverse homodigital artery island flap can provide good texture and contour matching the recipient area, good function and l ittle trauma at donor site.
Objective To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger. Methods Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm × 1.5 cm to 4.0 cm × 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm × 2.5 cm. All the donor sites were directly sutured. Results The flaps of 25 cases survived well after operation, and wound healed by first intention； 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension. Conclusion The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.