Combined index finger pollicization with an anterolateral thigh flap for thumb reconstruction / 中华创伤杂志(英文版)

A severe crush injury to the hand is devastating to patients. Under conditions in which the crush force is too great, the digits are not viable candidates for replantation. We present two cases in which the patients suffered from loss of the thumb ray at the first carpometacarpal joint and skin defect at the radial side. The tendons, radial nerve and metacarpal bone of the index finger were injured, and the second metacarpal head was retained. There was a comminuted fracture of the trapezium in both patients. The treatment protocols consisted of the index finger pollicization and the free anterolateral thigh flap transfer. The procedure was performed in a single operation. The new thumb is able to provide a stable post for pinch and grip after six months follow-up. Both patients were satisfied with the function and appearance of the reconstructed thumb.

Dorsalis pedis arterialized venous flap for hand and foot reconstruction / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.</p><p><b>METHODS</b>Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps, including five patients with skin defects of the hands, and one with defects at the dorsum of the foot. The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm multiply 5.5 cm to 6 cm multiply 11 cm. Two veins at the proximal margin of the flap were retained, one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.</p><p><b>RESULTS</b>All flaps demonstrated mild edema and survived completely. Blisters appeared on four flaps. Using this technique, we achieved good functional and cosmetic results in this series.</p><p><b>CONCLUSIONS</b>Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps, thereby improves reliability and utility for extremity reconstruction.</p>

Treatment of degloving injury of three fingers with an anterolateral thigh flap / 中华创伤杂志(英文版)

The degloving injuries of the digits and palm remain a persistent challenge. We used an antero- lateral thigh flap to treat an 18-year-old, right-handed male worker with degloving injuries of the index, middle and ring fingers. The flap was designated to wrap the entire circumference of three fingers sustaining degloving injury and to form mitten-hand. The total lengths of the distal phalanxes of three fingers were retained almost complete. The donor defect was covered with split-thickness skin graft. Three months after the first operation, roentgenograms revealed terminal phalanxex resorption in three injured fingers, and the surgical syndactyly between the middle and ring finger was separated at the same time. One month later, the syndactyly between the index and middle fingers was also separated. Good coverage of the soft tissue defects with good function and appearance was achieved. Therefore, we considered that the length of the degloved finger could be preserved using free flap.

Successful replantation of both lower legs in a 41-year-old man / 中华创伤杂志(英文版)

Both severed legs were replanted in a 41-year-old man. Bilateral tibia and fibula were shortened by 4 cm equally. Tibial fixation was performed with reconstruction plate. Four weeks after the replantation, active and passive exercises were initiated in both of the knee joints. Four months after surgery, the patient was capable of walking independently for 20-30 m without the aid of crutches. After 28 months' follow-up, plantar sensitivity was defined as S3. This patient was satisfactory with the cosmetic and functional results.