ABSTRACT
Objective To study the effect of Ilizarov technique on thumb shortening and bone defect after trauma.Methods The clinical data of 20 patients with thumb shortening or bone defect treated by Ilizarov technique from April 2010 to January 2018 were retrospectively analyzed.There were 19 males and 1 female including 15 left fingers and 5 right fingers.The age ranged from 20 to 56 years,with an average of 33.1 years.The osteotomy plane included 9 cases at distal part of the metacarpal,6 cases proximal phalanx base,1 case interphalangeal joint and 1 case distal part of proximal phalanx.Two cases were osteomyelitis after proximal and distal phalanges trauma,which resulted in interphalangeal joint defects after lesion clearance,and the length of the joint defect was 0.5 cm and 0.7 cm respectively.One case was emergency finger shortening fusion,which resulted in metacarpophalangeal joint defect due to nonunion of fusion site,and the length of the joint defect was 0.5 cm.Causes of injury included mechanical strangulation (12 cases),crush injury (6 cases) and traffic injury (2 cases).Semi-ring external fixator was used to extend the extension.There were 15 cases of metacarpal bone osteotomy and 5 cases of proximal phalanx osteotomy,prolonged from the 5th day after surgery.The osteotomy was prolonged by 0.5 mm every day,once every 6 hours.Results The follow-up time ranged from 184 to 446 days with an average of 244.6 days.The average extension period was 62.2 days (26-118 days),and the average extension length was 3.1 cm (1.3-5.9 cm).The healing index was 43.7-84.1 d/cm and the average healing index was 64.8 d/cm.The external fixed extender was used for 114-376 days with an average of 206.3 days.The distraction index was 20.1 c/cm (range,19.5-21.4 d/cm) and the maturity index was 46.5 d/cm (range,39.4-110.1 d/cm) and the external fixation index was 66.5 d/cm (range,60-130.8 d/cm).The finger pointing function and sensory function of thumb were restored after operation.According to the trial criteria of thumb and finger reconstruction function evaluation in the upper limb part evaluation criteria of Hand Surgery Society of Chinese Medical Association,11 cases were excellent,9 cases good,and the excellent and good rate was 100％(20/20).The two-point discrimination was 4-9 mm.The patients were satisfied with the function and appearance.Conclusion Ilizarov technique is a good method to treat thumb shortening and bone defect after trauma.
ABSTRACT
Objective To compare the clinical effect and operation difficulty of the combined skin flap with reversed proper palmar digital arterial dorsal branch island flap and cross-finger flap and the abdominal flap in the treatment of distal finger degloving injury.Methods Inclusion criteria:①Soft tissue defect far beyond the level of distal interphalangeal joints.②The inured finger was from second to fifth.③Single finger injury.④ Iniury time within 8 h.Exclusive criteria:①With tendon injury.② Multiple finger injuries.③Followed-up time within 6 months.Between February,2009 and September,2016,52 patients (52 fingers) with distal finger degloving injury were reviewed,there were 32 males and 20 females,aged from 18 to 60 (36.02±11.00) years.The time from injury to operation was 2.5-8.0 (4.81±1.28) h.Affected fingers included index finger in 15 cases,middle finger in 22 cases,ring finger in 10 cases,and little finger in 5 cases.Twenty patients (20 fingers) were treated by combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap(group combined-flap).The cubital skin was grafted onto the donor sites.Thirty-two patients (32 fingers) were treated by abdominal flap (group abdominal-flap).Results The patients were followed-up 6-25 (9.25±3.97) months.The operation time:group combined-flap was 80-130 (98.46±8.34) min and group abdominal-flap was 85-125(107.84±8.63)min.There was no significant difference in two groups (P＞0.05).Pedicle division time:group combined-flap was 15-24 (16.75±1.74) d and group abdominal-flap was 24-45 (28.31±5.12) d.There was a significant difference in two groups (P＜0.05).And the pedicle division time in group combined-flap was much shorter than in group abdominal-flap.Flap function at last follow-up,the excellent and good rate of the flap in group combined-flap and group abdominal-flap was 90.00％ and 59.38％,respectively.There was a significant difference in two groups (P＜0.05),and the flap function in group combined-flap was much better than in group abdominal-flap.Affected finger function at last follow-up,the excellent and good rate of the affected fingers was 95.00％ and 71.88％.There was a significant difference in two groups (P＜0.05),and the affected finger function in group combined-flap was much better than in group abdominal-flap.Conclusion The combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap is a simple and high-survival-rate flap,whose texture,appearance and clinical outcome for repair of distal finger degloving injury are much better than traditional abdominal flap.