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Objective:To discuss the clinical curative effect of the minimally invasive percutaneous suture technique of eight times for repairing closed injury extensor tendon zone I of finger.Methods:From February 2017 to January 2020, 12 patients (male 8, female 4) with mallet finger deformity were retrospectively studied, with an average age of 35 years (range, 18-50 years). And all the affected fingers were acute closed rupture of extensor tendon in zone I of single finger, 5 cases of the left finger and 7 cases of the right finger. There were 1 case of the thumb finger, 2 cases of the index finger, 3 cases of the middle finger, 4 cases of the ring finger and 2 cases of the little finger. 12 patients with fresh sputum mallet fingers were with 3-0 thread monofilament suture on extensor tendon zone I of finger in the minimally invasive percutaneous suture technique of eight times, and the distal end of the tendon was fixed to the base of the distal phalanx through the bone hole. Removal of the Kirschner wire 6-8 weeks, the brace was used to fix the affected finger in the dorsal extension. The flexion and extension of the affected finger was gradually strengthened. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up. The active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total action movement (TAM) of the finger were recorded. Finger function was evaluated according to TAM of the American Association of Hand Surgeons.Results:All operations were successfully completed, the operation time of the patients ranged from 18 to 25 min, with an average of 20.1±0.2 min. There was only a small amount of bleeding in the surgery. All 12 cases were followed up and the follow-up periods ranged from 6 to 14 months, with an average of 10.2±1.1 months. Mallet finger deformities were all corrected postoperatively; there were no knot exposure, skin necrosis and other complications. According to the Crawford standard, 9 cases were excellent, 2 cases were good, and 1 case was fair. The excellent and good rate was 91.7% (11/12). The mean active flexion of distal interphalangeal joints on the wounded finger and healthy finger were 82.11°±2.02° and 84.09°±2.01°, the mean active extension of distal interphalangeal joints on the wounded finger and healthy finger were -2.04°±3.01° and 0.02°±1.02°, there were significant differences between them ( t=2.447, 3.246; P=0.019, 0.004). The degrees of active joint activity of wounded finger were: 91.02°±4.01° of the metacar-pophalangeal joint, 94.04°±2.11° of the proximal interphalangeal joint, 83.01°±2.02° of the distal interphalangeal joint, and 265.05°±13.04° of total active activity; the degrees of active joint activity of healthy finger were: 93.01°±3.21° of the metacar-pophalangeal joint, 94.03°±3.07° of the proximal interphalangeal joint, 85.02°±2.01° of the distal interphalangeal joint, and 269.02°±12.10° of total active activity. The TAMs of the healthy side were 269.02°±12.10°, and the TAMs of the affected side were 265.05°±13.04°, there was no significant difference between them ( P>0.05). According to TAM system assessment criteria: excellent in 9 patients, good in 3 patients, and the excellent and good rate was 100% (12/12). Conclusion:The minimally invasive percutaneous suture technique of eight times can well repair closed injury extensor tendon zone I of finger, can have satisfactory treatment outcome in mallet finger with a simple procedure and good outcome. It is a simple, safe, effective method with minimal invasion.
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<p><b>OBJECTIVE</b>To investigate effect of veno-arteriolization of finger lateral vein for repairing severed finger tips.</p><p><b>METHODS</b>From March 2007 to April 2012, 20 patients with severed finger tips were treated with veno-arteriolization of finger lateral vein after failure in anastomosing artery of finger over times. During operation, the dominant digital artery at proximal end and the dominant finger lateral vein at distal end was anastomosed as the blood supply, the non-superiorty finger lateral vein was anastomosed as the blood drainage.</p><p><b>RESULTS</b>All flaps survived completely and achieved primary healing. 18 patients were successfully followed up for 6 to 12 months with satisfactory appearance and nail growth. Finger pulp was plump with good flexibility. The average length of nail was (15.6 +/- 2.7) mm and the average motion of DIP joint was (62 +/- 4) degrees. The average two point discrimination was (4.6 +/- 0.3) mm and the average sensation measurement was S3+.</p><p><b>CONCLUSION</b>The veno-arteriolization of finger lateral vein is a valuable method for repairing severed finger tips, which can promote nail growth, and restore fingers motion and sensation.</p>
Subject(s)
Humans , Anastomosis, Surgical , Methods , Arteries , General Surgery , Finger Injuries , General Surgery , Fingers , Plastic Surgery Procedures , Methods , Skin Transplantation , Surgical Flaps , Veins , General Surgery , Wound HealingABSTRACT
Objective To explore the clinical effect of Veno-arteriolization in digit replantation and reconstruction and transplantation of flap.Methods All clinical data of 49 cases of vascular special conditions were divide which received surgical treatment,21 cases in replantation group,5 cases in reconstruction group,23 cases in transplantation of flap group.All patients underwent veno-arterionlization.Results Two cases necrosis in transplantation of flap group,all the other fingers survived uneventfully.The patients were followed up for (4.5 ± 0.6)months.The outcome was satistactory both functionally and cosmetically in replantation and reconstruction groups.2-PD was (9.5 ±0.5) mm in replantation group,2-PD was (10.5 ± 1.0) mm in reconstruction group.The flaps had excellent appearance,good texture and color match in transplantation of flap group.According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975,the results of this series showed excellent in 42 cases,good in 5 cases and fair in 2 cases,the excellent and good rate was 95.9％.Conclusions Veno-arteriolization was a new method for hand surgery trauma in specially circumstances.Owing to its simple procedure,reliable effect,it worth to be spreading.
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Objective To investigate effect of finger lateral veins anastomosis for restoring venous return of severed fingertip.Methods From March 2008 to December 2012,36 patients underwent finger lateral veins anastomosis,including 21 males and 15 females,aged from 15 to 52 years (average,29.5±6.6 years).The thumb was involved in 3 cases,the index finger in 9 cases,the middle finger in 9 cases,the ring finger in 7 cases,and the little finger in 8 cases.The causes of injury included crush injury in 12 cases,electric saw injury in 8 cases,and incised injury in 16 cases.According to type of fingertip injury,there were 14 cases of type Ⅰ,5 cases of type Ⅱ,10 cases of type Ⅲ,and 7 cases of type Ⅴ.The ratios of anastomotic artery and veins were 1∶1,1∶2 or 2∶2 (average,1∶2).Results Thirty-six fingertips survived completely and no venous return obstruction happened,arterial crisis occurred in 3 cases after operation,which were cured after operative and medication treatment.Thirty patients were successfully followed up for 6 to 24 months (average,12.4±2.8 months).The fingers' appearances were satisfactory,finger pulps were plump with good flexibility,and no obvious atrophy of finger was found.The nails were nearly smooth,and the length of nails ranged from 10.5 to 18.9 mm (average,14.4±3.2 mm).The motion of distal interphalangeal joints,the two point discrimination,and the results of sensation measurement ranged from 0° to 70° (average,63°±5°),4.2 to 6.0 mm (average,4.6±0.4 mm),and S3 to S4,respectively.According to Tamai's classification,Tamai score increased from 68 to 100 at final follow-up,the results were excellent in 28 cases,good in 2 cases,with an excellent and good rate of 100％.Conclusion The finger lateral veins anastomosis is an effective method for restoring venous return of severed fingertip,which can avoid venous return obstruction,promote growth of nail,and restore motion and sensation of fingers.
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Objective To investigate effect of double end-to-side neuroanastomosis for bilateral obsolete proper digital nerve injuries.Methods From November 2000 to October 2009,40 patients with bilateral obsolete proper digital nerve injuries were admitted to our center.Fifteen patients underwent double end-to-side neuroanastomosis.During operation,the injured digital nerve was excised,then bilateral distal ends and proximal ends were sutured,respectively; consequently,the distal and proximal nerve bows were formed.A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm,then divided equally to 2 parts which were used to bridge the 2 nerve bows.Thirteen patients underwent single end-to-side neuroanastomosis,while other 12 patients underwent end-to-end neuroanastomosis.Results Thirty one patients were successfully followed up for 6 to 8 months.In double end-to-side neuroanastomosis group,12 patients were successfully followed up; anaesthesia and pain of the injured fingers disappeared completely; finger pulp was plump with good flexibility; the average result of sensation measurement was S(4.21 ±1.97),which was significantly higher than those of the other 2 groups; the average result of two point discrimination was 5.4±0.9 mm which was significantly lower than those of the other 2 groups.In single end-to-side neuroanastomosis group,10 patients were successfully followed up; anaesthesia relieved and spontaneous pain disappeared completely,but there was still tenderness; the average result of sensation measurement was S(1.57±0.72); the average result of two point discrimination was 7.2±1.2 mm.In end-to-end neuroanastomosis group,9 patients were successfully followed up; anaesthesia and pain relieved; the average result of sensation measurement was S(3.19± 1.04); the average result of two point discrimination was 7.68±0.8 mm; there were significant differences in results of sensation measurement and two point discrimination between the latter two groups.Conclusion The double end-to-side neuroanastomosis is a valuable method for repairing bilateral obsolete proper digital nerve injuries.