Repair of concurrent skin and nerve defect at palm and carpal on ulnar side with free medial plantar flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore a new method for repair of concurrent skin and nerve defect at palm and carpal on ulnar side.</p><p><b>METHODS</b>From April 2000 to August 2009, five cases with concurrent skin and nerve defect at palm and carpal on ulnar side were reconstructed with free medial plantar flaps. Palmar nervous proprii defect at ulnar side of little finger was repaired by the first toe tibia nervous proprii in one case. The superficial branch of radial nerve was applied to repair the defect of ulnar nerve, as well as its deep or superficial branch in two cases. The superficial branch of radial nerve was also used to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, Little finger ulnar palmar nervous proprii in one case. The dorsal branch of ulnar nerve was applied to repair the defect of superficial branch of ulnar nerve, common palmar digital nerve of the fourth finger, little finger ulnar palmar nervous proprii in one case. The vascular bundle of medial plantar flap was anastomosed with ulnar vascular bundle. The wounds at donor sites were covered with free skin grafts which were obtained from upper leg.</p><p><b>RESULTS</b>All the flaps and skin grafts were survived completely. The five patients were followed up for six months to four years with no muscular atrophy or claw hand deformity. The esthetic result was satisfied. The Sensory of flaps and fingers recovered to S3 to S3+. The two-point discrimination distance on flaps was range from 7 mm to 10 mm. The postoperative comprehensive evaluation was excellent in the cases whose superficial and deep branches of ulnar nerve were repaired.</p><p><b>CONCLUSIONS</b>Free medial plantar flap is an effective method to repair concurrent skin and nerve defect at palm and carpal on the ulnar side.</p>

The reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion / 中华整形外科杂志

<p><b>OBJECTIVE</b>To discuss the application of reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion.</p><p><b>METHODS</b>From Jan. 2005 to Mar. 2008, 28 cases with degloved fingertip avulsion were treated with reverse flaps based on two dorsal metacarpal artery. The defects were located distal to the distant interphalangeal joints and were 0.8-2.2 cm in length. 10 defects was in the index fingers, 13 in the middle fingers and 5 in the ring fingers. 24 fingers were treated in an emergency surgery. 4 fingers were treated due to skin necrosis.</p><p><b>RESULTS</b>Epidermal necrosis happened at the distal end of flaps in 3 cases. All the other flaps survived completely. 25 cases were followed up for 4-27 months with satisfactory cosmetic and functional results. The 2-points discrimination distance was 6.0-9.0 mm (average, 7.6 mm).</p><p><b>CONCLUSIONS</b>The reverse flap based on two dorsal metacarpal artery is easily performed and reliable for degloved fingertip avulsion with satisfactory results.</p>