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Objective:To explore the surgical method and therapeutic effect of repairing soft tissue defect of digit-tip with single subcutaneous pedicle V-Y advancing flap combined with skin grafting.Methods:From August 2013 to December 2020, 25 soft tissue defects of digit-tip were repaired by a single subcutaneous pedicle V-Y advancing flap combined with pedicle skin grafting. The area of the defects was 0.8 cm× 0.8 cm to 1.6 cm× 1.4 cm. The flaps were harvested from palm or lateral side of the wound and the area of flap was 0.5 cm×1.0 cm to 0.8 cm×2.5 cm. In order to make the flap transfer to a further distance, the subcutaneous fibre connection of the flap was cut-off during the operation. At the same time, cut off 1 side of subcutaneous pedicle. Finally, the advanced distance of the flap reached 0.5-1.2 cm. After the flap harvested, the medium thickness skin was removed for graft to close the donor site from the wrist striations. After the surgery, follow-up visits were conducted regularly by outpatient clinic, or via telephone or WeChat review or by home visit. Throughout the follow-up, the flap appearance, sensation and recovery of the function of digital joint were observed, together with the patient satisfaction. Results:After the surgery, the postoperative follow-up lasted for 4 months to 8 years. All 25 flaps and skin grafts were survived in first stage wound healing. The flaps and skin grafting areas had excellent texture. The fingerprint had been reconstructed with good appearance. The TPD was 4-9 mm, the functions of digital joint recovered well, and there was no complain about a discomfort at the donor site. According to the evaluation standard of Michigan hand function questionnaire, all 25 patients were very satisfied with the overall appearance and function of the hand. According to Total Angle of Motion (TAM) evaluation standard, finger mobility was excellent in all 25 patients.Conclusion:Subcutaneous V-Y advancing flap combined with skin grafting is an ideal method for repairing soft tissue defect of digit-tip. The surgery characterises a simple flap cutting, less traumatic damage, long advancing distance of flap and good repair effect.
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Objective:To explore the surgical technique and therapeutic effect of flap wrapping repair of soft tissue defect after digit degloving injury with free arm medial perforator flap.Methods:From October 2009 to December 2020, 15 patients with soft tissue defect after digit degloving injury were repaired with free arm medial perforator flaps. The patients were 9 males and 6 females aged 22 to 50 years old, with an average of 32 years old. Injury mechanism: 13 cases of machine strangulation and 2 cases of machine crushing. Plane of sleeve avulsion injury: at the distal metacarpophalangeal joint of thumb in 2 cases, at the middle and distal segment of single finger of 2nd to 5th fingers in 4 cases, and at distal metacarpophalangeal joint of 2nd to 5th fingers in 9 cases. Seven cases were in left hand and 8 in right hand. Emergency surgery was performed in 2 cases and scheduled surgery in 13 cases. The flap was designed in a shape of a long strip, and the size of the flap was 5.0 cm×2.5 cm-14.0 cm×3.5 cm. During the operation, the artery of the flap pedicle was anastomosed with the palmar digital proper artery or common digital artery of the recipient digit, the subcutaneous vein or the companion vein of the artery was anastomosed with the dorsal or palmar digital subcutaneous vein, and the medial brachial cutaneous nerve carried in the flap was anastomosed with the stump of palmar digital proper nerve. All the donor sites were directly sutured. After the surgery, follow-up visits were conducted regularly at outpatient clinic, or via telephone and WeChat review or by home visit. The flap appearance, sensation and function recovery of digital joints were observed together with the patient satisfaction. Results:All flaps survived successfully after surgery. Six patients with degloving defect of the whole digit had encountered poor wound healing caused by distal phalangeal necrosis. The second stage stump trimming was performed to keep the digit to the distal end of the middle segment. Two cases of thumb and 2 cases of middle finger suffered further burning and worn tears at 7-9 months after surgery and self-healed. The follow-up period was 6-28 (average 16) months. The flap was soft without bloating. The sensation recovered to S 2-S 3. The shape of fingers was good, and no secondary flap surgery was necessary. The overall movement of interphalangeal joints was poor. According to the evaluation standard of Michigan hand function questionnaire, 15 patients achieved very satisfactory with the overall appearance and function of hands. The linear scars at donor site were hidden without complications such as tenderness and contraction. Conclusion:The free medial perforator flap of the arm is easy to design and thin, hence does not affect the shape of a digit. So, it is ideal for the repair of soft tissue defect after digit degloving injury.
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Objective:To investigate the surgical method and therapeutic effect on repairing soft tissue defects around ankle with lateral tarsal artery island flap.Methods:From July 2013 to December 2020, the lateral tarsal artery island flap were used to repair the soft tissue defects around ankle in 12 patients in Hand Surgery Department, Jiangnan Hospital Affiliated to Binjiang College. Of which, 6 patients had soft tissue defects complicated with bone or tendon exposure after injury and 6 had skin necrosis with internal fixation after fracture. The area of soft tissue defects was 6.0 cm×4.0 cm-9.0 cm×5.0 cm, and the size of the flaps was 7.0 cm×5.0 cm-10.0 cm×6.0 cm. After the flap was freed, the vascular pedicle was separated up to the origin of dorsalis pedis artery. As the pedicel was not long enough in 1 patient, the dorsal pedis artery was ligated and transected at the origin of the lateral tarsal artery. Full thickness skin graft was used to repair the donor sites. The patients were treated with anti-infection and anticoagulant therapies. The postoperative follow-ups were conducted by outpatient clinic visit, telephone or WeChat interviews or home visit to observe the recoveries in texture, appearance, sensation, donor site and function of ankle.Results:All the flaps and skin grafts survived. The wound healed well without occurrence of ulcer. The follow-up ranged 6-108 months (mean 17 months). Appearance of the flaps was good. It was not bloated and the sensation was restored to S 2-S 3. Conclusion:It is a good method to apply the lateral tarsal artery island flap in repair of the soft tissue defects around ankle. It features a hidden donor site, simple operation and the high level of safety. The texture and appearance of the flap are close to those of the recipient site.
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Objective:To explore the surgical method and therapeutic effect of repairing thumb pulp defect with pedicled transposition of radial proper palmar digital artery flap of middle finger.Methods:Since June, 2006 to May, 2020, 17 cases(17 fingers) with thumb pulp defect were repaired by pedicled transposition of radial proper palmar digital artery flap of middle finger. The sizes of flap ranged from 1.5 cm × 1.5 cm to 4.2 cm × 2.0 cm. The antegrade pedicled flap of radial proper palmar digital artery of middle finger was used in 2 cases and the retrograde pedicled flap of middle finger was used in 15 cases. After the flap was resected, the donor sites were covered with a medium thickness skin graft transferred from the wrist or elbow. The skin graft did not need to be packed. The dorsal branch of the digital nerve was included in the flap and it was anastomosed with the proper nerve of the injured thumb stump. After 16-22 days of the operation, the pedicles were cut off. The patients were instructed to perform digit function exercise after the pedicle was cut off. After the operation, the patients were included in regularly follow-up through outpatient visit, telephone or WeChat interview. The appearance and sensation of the thumb and finger pulps and the function recovery of the thumb and finger joints were observed through the followed-ups.Results:All 17 flaps and donor site skin grafts survived over 3 to 32 months of follow-up. The flaps achieved good texture and natural appearance. The TPD recovered to 5~11 mm. According to the Michigan Hand Function Questionnaire, all the 17 patients were very satisfied with the overall appearance and function of the hands. According to TAM, the 17 cases were all in excellent.Conclusion:Repairing thumb pulp defect with radial proper palmar digital artery pedicled flap of middle finger, the flap resection is simple, and the donor site is hidden. The appearance and texture of flap is good. It is a safe, effective and good method.
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Objective:To explore the surgical method and therapeutic effect of repairing digital tip defect with free flap of proximal perforating branch of proper palmar digital artery.Methods:From March, 2009 to January, 2021, 15 patients with soft tissue defects at the tip of 16 digits were repaired with free perforator flap of proper palmar digital artery. The flap was obtained from the ulnar side of an index finger, on both sides of a middle finger and on the proximal side of the radial side of the ring finger. The size of flaps was 1.8 cm × 1.2 cm - 4.5 cm × 2.2 cm. The flap carried dorsal branch of proper palmar digital nerve and 0.5-4.5 cm of arteriae digitales palmares propriae. The donor digital artery was re-anastomosed in 3 cases 3 digits, transferred and anastomosed in 2 cases and un-anastomosed in 10 cases 11 digits. The dorsal branch of the proper palmar digital nerve in the flap was anastomosed with the proper palmar digital nerve of the finger stump at the recipient site to restore the sensation of flap, and the donor sites at the wrist transverse stripes or elbow transverse stripes were directly sutured. Regular follow-up via outpatient visit, telephone or WeChat interviews was conducted to observe the appearance, sensation and recovery of the flap and finger joint function.Results:After surgery, the flaps and donor site skin grafts of 15 cases with 16 digits were all survived, with first stage healing. A 4 months to 12 years follow-up showed that the flaps were in good texture and full shape with TPD at 7 - 11 mm. The joint function of digits was recovered well, and there was no complaint about uncomfortable donor site. According to the Michigan Hand Function Questionnaire, all 15 patients were satisfied with the overall appearance and function of the hands. According to TAM evaluation standard, all the digits of 15 patients were in excellent.Conclusion:Free flap of the proximal perforating branch of proper palmar digital artery is an ideal in the repair of digital tip soft tissue defect, as it has the advantages of an anatomical constant vessel, hidden donor site, less trauma caused, simple flap resection and good therapeutic effect.
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Objective:To investigate the surgical method and therapeutic effect of reconstruction of distal blood supply of multiple segments of severed finger body by ortho phalanx artery bridge transfer.Methods:Between November, 2005 and February, 2019, 7 finger body was replanted in 7 cases with 3 segments. Due to the short middle finger body and severe bruising, the power could not pass through the middle section after the proximal finger artery anastomosis. For the long section of blood supply, in order to prevent the skin and blood vessels from separating too much and causing the middle internal artery to separate from the phalanx, after anastomosis of the middle artery, the blood supply was provided by anastomosis with the distal phalanx artery by means of the adjacent phalanx artery bridge. Four cases with vascular pedicle grafts. The skin was sewn into tube in 3 cases, and separate fingers between 3.5 and 6.0 months after operation. Four cases of posterior artery recalcitration and 3 cases of direct adjacent artery transposition. The appearance, sensation and total motion of finger joints were observed and the satisfaction of patients was investigated to evaluate the therapeutic effect.Results:Seven patients with replantation finger were all alive after operation, and the follow-up time was 5 to 40 months respectively. The total range of motion of flexion and extension of finger joints was 100°-170°, and the TPD of finger pulp was 7-12 mm, with an average of 9.6 mm. According to Michigan's functional questionnaire, 7 patients were satisfied with the overall appearance and function of their opponents. According to the evaluation standard of the replantation function of the broken finger of the Chinese Medical Association, 3 cases were excellent and 4 cases were good.Conclusion:It is a simple and effective way to reconstruct the blood supply of multi-segment severed fingers by means of adjacent finger artery bridge transfer.
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To evaluate the surgical technique and clinical effect of applying Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel. Methods From February, 2013 to March, 2018, 9 cases of severed fingers composited defect of soft tissue and vessel were treated with Flow-through flap pedicled with superficial palmar branch of radial artery.The flap was designed from the proximal end of rasceta and the donor sites were sutured directly. The size of flaps was 3.0 cm ×1.5 cm-4.0 cm×2.2 cm. The superficial branch of the radial artery in the flap was used to bridge the finger artery. And the vein of proximal and distal ends in the finger was bridged by the subcutaneous vein. The proper palmar digi-tal nerve defect was bridged by palm skin graft of median nerve. The appearance, feeling and joint function of fingers was followed-up regularly after operation. Results All transfering flaps survived and all cases were followed-up for 7 to 33 months. The donor sites got primary healing with straight scars. The appearance and texture of the flaps were satisfactory. Two-point discrimination ranged from 8 to 11 mm. The pain sensation, warmth sensation and touch sen-sation of the flaps got better. And the appearance and functions of severed fingers recovered well. Conclusion The Flow-through flap pedicled with superficial palmar branch of radial artery is easy to harvest and anastomose, which is masked and a small incision for the donor site. It is an ideal method for bridging severed fingers and repairing of fin-ger wound.
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In July 2016, we used free superficial palmar branch of radial artery flap to repair one case of complete dissection of the thumb with skin defect, and achieved good result .
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Objective@#To assess the effect of combined treatment using cell scaffold and human fibroblast growth factor for small soft tissue defects of digits caused by trauma.@*Methods@#From May 2012 to September 2016, twenty cases of small soft tissue defect of digits were repaired with cell scaffold combined with recombinant human basic fibroblast growth factor. The average defect area was 2.5 cm2. Wounds were debrided and repaired with artificial dermis. Every 2 or 3 days the dressings were changed and the wounds were treated externally with fibroblast growth factor until cell scaffolds have been removed 3-4 weeks after surgery.@*Results@#The group of 20 cases was followed up for 2-24 months. Wounds were healed with satisfactory appearance and no recurrence of wound or obvious hypertrophic scar was observed. No obvious functional problem was found in interphalangeal motion.@*Conclusions@#The method of repairing wound with cell scaffold combined with human fibroblast growth factor is simple and it result in healing of wounds with high quality.It provides a new choice for repairing wound in digits.
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Objective To explore the surgical technique of applying the pedicle composite tissue flap based on superficial palmar branch of the radial artery to repair the soft tissue defect of thumb and evaluate the clinical ef-fect. Methods From February,2013 to March, 2016, 5 cases of the soft tissue and tendon defect of thumb were treated with the pedicle composite tissue flap based on superficial palmar branch of the radial artery. The flap was de-signed at wrist not exceeding the wrist rasceta and the donor site was sutured directly. The size of the harvested flaps was between 3.0 cm ×2.2 cm to 4.2 cm ×3.2 cm, and the sensation of thumb or the flap was reconstructed via median nerve cutaneous branch. The Extensor pollicislongus muscle tendon defect was repaired via palm tendon carried by composite tissue flap. Postoperative follow-up was done termly. Results All transfering flaps survived and all cases were followed-up for 4 to 11 months. The donor site got primary healing with a linear scar. The appearance and tex-ture of the flap was satisfactory. The two-point discrimination ranged from 8 to 11 mm. The appearance of thumb re-covered well and the digit joint had a good motion. Conclusion The pedicle composite tissue flap based on superfi-cial palmar branch of the radial artery is easy to harvest and its vascular anatomy is constant, which is masked and a small incision for the donor site. When necessary, palm tendon or median nerve cutaneous branch can be contained in the flap to form a composite transplant. It is an ideal method for repair of thumb soft tissue defect.
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Objective To evaluate the surgical technique and the clinical effect of applying free superficial palmar branch of the radial artery flap to repair soft tissue defect of finger pulp.Methods From June,2011 to December,2013,12 cases of soft tissue defect of finger pulp and bone exposed were treated with free superficial palmar branch of the radial artery flap.The flap was designed from the proximal end of palmar wrist and the donor site was sutured directly.The size of the harvested flaps was between 2.5 cm × 1.0 cm and 6.2 cm × 3.8 cm,and the sensation of the flap was reconstructed via median nerve cutaneous branch.Results All transfering flaps survived and all cases were followed up for 4 to 17 months.The donor site got primary healing with a straight car.The appearance and texture of the flaps were satisfactory.2-point discrimination ranged from 6 to 11 mm.The pain sensation,warmth sensation and touch sensation of the flap got better.Conclusion The free superficial palmar branch of the radial artery flap is easy to harvest and anastomose,which is masked and a small incision for the donor site.The appearance and sensation of the flap which has sensory nerve branched for sensory reconstruction is satisfactory.It is an ideal method for the repairment of finger pulp defects.
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Objective To explore the clinical effect that the free twin-flap with the first dorsal (bottom) metatarsa artery repair the defects of distal in adjacent two fingers.Methods The twin-flap from the big toe and the second toe based on a single vascular pedicle of the firstl dorsal (bottom) metatarsa artery was designed in this article.From November 2010 to June 2013,this twin-flap was transferred in 9 patients.In order to solve the problems:the shortage of arterial span,the bone and (or)tendon exposed in the donor site,the thickness skin graft resurfaced in the donor site was not easy to survive,the bare vascular pedicle and the donor site were covered with artificial dermis for 3 weeks.After 3 weeks,cutting skin bridge and removing the thin of artificial dermis,the donor site was resurfaced by thickness skin graft.Results All cases were followed up for 4 to 12 months.All transfering flaps and the thickness skin graft were survival.The colours and texture of the flaps matched the recipient site.2-point discrimination ranged from 8 to 12 mm.Finger flexion and extension was satisfactory.The appearance of the donor site was well-stacked.No case had successive ulces,pain and car.Conclusion The twin-flap from the big toe and the second toe based on a single vascular pedicle of the first dorsal (bottom) metatarsal artery combined with artificial dermis to repair the defects of distal in adjacent two fingers.For one side,this operation can solve he shortage of arterial span and repair the defects of distal in adjacent two fingers at the same time.For another,it can provid a easy method for deal with the donor site and raise the survial rate of the thickness skin graft.Besides,it also is easy and safe,clinical effect is satisfaction.
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Objective To summarize clinical experience of application of muliplefoliated flap combined with tendon graft from dorsal foot for repairing soft tissue defects of multi-fingers. Methods Based on the results of microdissection researches, muliplefoliated flap including medial foot flap, the first metatarsal dorsal flap, lateral foot flap, extensor pollicis brevis of toe and extensor proprius of the fifth toe pedicled by anterior tibial vessels and dorsal pedis vessels as trunk, anterior medial malleolus vessels, the first metatarsal vessels and anterior lateral malleolus vessels as branches respective was designed for repairing soft tissue and tendon defects of multi-fingers. Results In all 12 cases, total survival of flap was 11 cases , 1 case had partial necrosis of distal flap and it was healed by dress changing. Conclusion Transplantation of muliplefoliated flap combined with tendon graft from dorsal foot is a good method to repair soft tissue and tendon defects of multi-fingers.
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Objective To explore clinical effect of repairing soft tissue defect in forearm, hand and foot with free super-thin anterolateral thigh perforator flaps. Methods At first the site of perforator vessels were determined by Doppler, then the flaps were designed and harvested with the site as center; the fascia lata and subcutaneous fat were removed by sandhill-likely only the 4.0 cm × 3.0 cm - 3.0 cm×2.5 cm disc-like fascia lata and dermis layer were reserved. 15 traumatic soft tissue defects including forearm, hand and foot were repaired with the ree super-thin antemlateral thigh perforator flaps. Results No vascular crisis happened and all skin grafts survived in donor sites. 2.0 cm×1.2 cm of the distal of flap was necrosis in 1 case and it was healed by dress changing. 15 cases were followed up 3 months-2 years and the average is 6 months. The contour and texture of all flaps were good and two point discrimination (2-PD) was about 8-10 mm of. Conclusions The contour and texture of free super-thin anterolateral thigh perforator flap are good, the feeling of recipient site recovered well, it's less injury for donor site and there is no reshaping for flap. It is a fineness donor site for repairing soft tissue defects in hand and foot.