Observation of the curative effect of two kinds of mini perforator free flap for digital injuries reconstruction / 中华显微外科杂志

Objective Discuss the clinical efficacy by using two kinds of mini perforator free flap for digital injuries reconstruction. Methods From August, 2014 to February, 2017, 45 patients were managed randomly with either radial artery superficial palmar branch(RASPB)perforator free flap or digital artery(DA)perforator free flap for digital skin defects reconstruction, and they were therefore divided into two groups according to the flap type. There were 24 patients in RASPB group, with an average wound dimensions ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm, and an average harvested flap size ranged from 2.0 cm×1.7 cm to 4.2 cm×2.6 cm. Another 21 patients were in DA group, with an average wound dimensions ranged from 2.0 cm×1.5 cm to 3.8 cm×3.0 cm, and an average harvested flap size ranged from 2.2 cm×1.6 cm to 3.9 cm×3.2 cm. The survival rate, sensory function, donor site complications, hand function recovery and aesthetic outcomes of two groups were compared by the SPSS22.0 statistical software after surgery. Results The mean follow up period was 15 months. All flaps were primary survived without vascular crisis. The flaps were soft in texture,trimness in appearance and none of them overtop the normal skin for more than 0.5 cm. Both groups had a favorable sensory recovery.All cases recovery to S3+or better.In Group RASPB,the mean two point discrimination(2 PD)was 7.85±1.15 mm(ranged from 7.0 mm to 9.0 mm). And it was 6.02±0.94 mm(ranged from 6.0 mm to 8.0 mm)in DA group. The difference between two groups was statistically significant(P <0.05). Then we synthetically analyzed flap texture and sensory function,and calculated the qualified ratio of each group.There was no significant difference between two groups(P > 0.05). The degree of scar contracture demonstrated donor site compli cations in RASPB group was lesser than that in DA group(P<0.05).The range of motion of interphalangeal joint was used to reflect the hand function. And we calculated the ratio of repaired and contralateral sites. The difference of the mean ratio between two groups was not statistically significant(P>0.05). Conclusion On account of the characteristics of invariant anatomy position, sufficient blood supply, favorable aesthetic outcome and minimal donor site mobility, both RASPB perforator flap and DA perforator flap were optimal for digital skin defects reconstruction.Besides,incorporated with nerve and tendon,the RASPB perforator flap can also be used for complex tissue transplantation,and the surgery field was only on the arm.While the DA perforator free flap had an advantage of better sensory recovery and appearance.

A Case Report of Nail Bed Reconstruction with Digital Artery Perforator (DAP) Flap and Buccal Mucosal Graft

PURPOSE: Many fingertip injuries are associated with nail injury and it is hard to repair to original shape due to its unique characteristic. Mucosal graft is used for a defect of the nail bed injury. Hereby, we introduce a DAP flap and buccal mucosal graft, with which we could reduce the defect size of the injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Also, mucosal graft makes good cosmetic and functional outcome of nail. METHODS: This method was performed in a 56-year-old man with fingertip injury on dorsal side of left thumb due to electrical saw. First, DAP flap was performed on the injured finger to reduce the size of the defect of fingertip and cover the bone exposure. Second, nail bed part of the DAP flap was de-epithelized and buccal mucosal graft was done from left side of intraoral cavity wall. RESULTS: Flap and graft survived without any necrosis but some nail bed could not be covered with flap due to insufficient flap size. All wounds healed well and did not present any severe adversary symptoms. CONCLUSION: DAP flap with mucosal graft is an effective method that we can easily apply in reconstruction of fingertip injury. We suggest that the combination of the two procedures makes good functional and cosmetic outcome compared to the usual manner, especially in cases of nail bed injury without distal phalanx bone defect.

Repair of fingertip defects with lateral flaps of finger based on digital artery perforator / 中华显微外科杂志

ObjectiveTo analysis the clinical efficacy of using lateral homodigital flaps based on digital artery perforator to repair the fingertip defects. MethodsFrom October 2008 to August 2010,nine patients with twelve fingertip defects,including 5 thumbs,2 index fingers,3 middle fingers,2 ring fingers,underwent repair with lateral homodigital flaps based on digital artery perforator.The size of the flaps ranged from 2.7 cm× 1.4 cm to 3.1 cm× 1.8 cm.The donor site were covered by skin graft. ResultsEleven flaps survived.One case met with partial necrosis.The follow-up time ranged from 3 to 6 months(average of 4.5 months).The finges had good appearance.Ten cases had gained full postoperative sensory recovery and the two-point discrimination was 4-Smm at 3 months after operation.ConclusionUsing the flaps pedicled with digital artery perforator is a feasible solution for treatment of fingertip defects.

Comparison Between the Digital Artery Perforator Flaps and the Distant Flaps within Hand

PURPOSE: The digital artery perforator flap was recently introduced and has been proven to be useful for reconstruction of various finger defects. Short operative time, less invasive surgery, and reliable flap circulation are the major advantages of this flap. The authors presented the clinical cases of the digital artery perforator flap and compared them with the distant flaps within a hand (thenar and hypothenar flaps) to reveal their differences. METHODS: From May of 2006 to February of 2009, the authors performed reconstructions of finger defects with the digital artery perforator flaps in 10 patients as with the distant flaps within hand in 9 patients (7 thenar and 2 hypothenar flaps). In these two groups of the patients, flap size, use of skin graft, length of stay in hospital, healing time, complications were reviewed retrospectively and compared with statistical analysis (Student's t-test). RESULTS: All flaps survived completely. The mean size of the perforator flap was 0.9 x 1.9 cm and the mean distant flap within a hand was 1.9 x 2.0 cm. The use of skin graft was reduced in the perforator group because the donor site of the flap was closed primarily. The hospitalization period and healing time also reduced significantly in the perforator group. Minor complications (partial flap loss) were noted in small percentages in both groups but resolved with conservative management. Mean follow-up period was about 6 weeks. CONCLUSION: The digital artery perforator flap was smaller than the distant flap but its reconstruction of finger defects was reliable and comparable to the conventional distant flaps within a hand. This flap would be not only an alternative method but very useful in the management of various finger defects, because of ease of operative technique, less invasive surgery, decreased need of skin graft, and shorter period of hospitalization and healing time.