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OBJECTIVE@#To explore asurgical methods for replantation of severed finger.@*METHODS@#From January 2018 to November 2022, 8 amputated-finger patients were performed surgical reconstructions by using polyfoliate free flaps with the first dorsal metatarsal artery, including 7 males and 1 female, aged from 20 to 55 years old, and defect areas ranged from (1.0 to 2.0) cm×(3.0 to 4.5) cm. Finger pulp sensation, shape and other relevant parameters were assessed following the upper extremity functional evaluation standard, which was put forward by Hand Surgery Branch of Chinese Medical Association. And maryland foot functional score was used to evaluate foot function.@*RESULTS@#Amputated fingers and flaps of all the 8 patients were survived. All patients were followed up for 4 to 20 months, their finger color and temperature tured to normal, with good wear-resistance and cold-resistance. According to Hand Surgery Branch of Chinese Medical Association, functional score ranged 61 to 92;4 patients got excellent result and 4 good. Maryland foot functional score ranged from 93 to 100;and 8 patients got excellent result.@*CONCLUSION@#It is feasible to repair severed fingers with soft tissue defects using polyfoliate free flaps that driven by the flippers of the first and second toes of the foot. This method ccould bridge blood vessels, increase soft tissue volume of the injured finger, and avoid finger shortening, with high patient satisfaction.
Subject(s)
Male , Humans , Female , Young Adult , Adult , Middle Aged , Foot/surgery , Lower Extremity , Surgical Flaps , Toes , Plastic Surgery ProceduresABSTRACT
Objective:To explore the clinical application of distal and proximal bilateral lateral pre-decompression in replant of digit degloving injury.Methods:From March 2012 to May 2021, 14 patients with 29 digits had replantation surgery of degloved soft tissue and severed digits in Section II, Department of Orthopaedics, Changzhou Medical District of 904th Hospital of PLA Joint Logistic Support Force. There were 2 types of injuries: degloving injury of soft tissue but with intact digital tip, and digital tip degloving injury with intact distal phalanx and nail bed. With the technique of distal and proximal bilateral lateral pre-decompression, pre-decompression incisions were made to the subdermal on both sides of the degloved skin over the proper palmar digital arteries. From where, the distal stump of the proper palmar digital arteries and nerves for anastomosis were found and had them anastomosed with the proximal proper palmar digital arteries and proper palmar digital nerves, then anastomosed digital pulp and digital dorsal veins (11 cases were direct anastomosis and 3 cases were bridged anastomosis). Follow-up was carried out by outpatient consultation, telephone and WeChat APP. The appearance of the digit body, the shape of digital pulp, the nails grow and the motions of the digits were observed, and the Evaluation Standard of Replantation of Severed Fingers by the Society of Hand surgery of Chinese Medical Association was used to evaluate the recovery of function.Results:All 29 segments of degloving digit survived. Small necrotic areas was found in 4 digits and healed after the change of dressing. The followed-up time was lasted for 3-36 months. There was no obvious atrophy found in all the digits. Appearances of digit pulp and nails were satisfactory with good sensational recovery for TPD at 6-10 mm, 7 mm in average. Motions of all the repaired digits were good. According to the Evaluation Standard of Replantation of Severed Fingers by the Society of Hand surgery of Chinese Medical Association, 23 digits were in excellent, 4 in good and 2 in poor, with a satisfactory rate at 93.1%.Conclusion:For a distal digit injury with intact distal soft tissue and relatively mild injury of blood vessels and nerves, using the method of distal and proximal bilateral lateral pre-decompression can help to achieve good appearance in survived digital pulp, good sensational recovery and good nail growth. An individualised treatment intra-and-after the surgery could offer an ideal therapeutic effect.
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Objective:To explore a surgical technique and treatment outcomes of the segmentle bridging reconstruction for severed fingers with single segmentle defect by using the free second toe bone-joint composite tissue combined with the great toe flap.Methods:From June 2010 to September 2017, 5 patients suffered from severed segmental defect of finger were treated. According to the defects of bone-joints, blood vessels, nerves, tendons and other soft tissues, the reconstruction surgery was designed to create a Flow-through bridging composite flap pedicled with the first dorsal metatarsal artery or the plantar artery. The blood vessles carried by the pedicle were anastomosed with the vessels in the finger to restore the blood supply to the distal finger while having the defected finger segment reconstructed. A Flow-through bridging composite flap was created by taking the second toe bone-joint composite tissue combined with a C-shaped or half-moon shaped flap from the fibular side of the great toe. Skin graft, retrograde lateral tarsal flap or free perforator flaps were used in 3 cases to repair the donor sites of the great and second toes. Iliac strip was implanted in 2 cases for toe salvage. Kirschner wires were removed 4-6 weeks after surgery followed by functional exercise.Results:All of the 5 reconstructed distal segments of the fingers survived with the healing of fractures in 8-12 week after surgery. The postoperative follow-up lasted 6-36 months and all the patients had the follow-ups at the outpatient clinic. It was found that the maximum flexion of the reconstructed interphalangel joint was 60 degrees together with dorsiflezion. According to the evaluation standard of the reconstructed function for thumb and finger issued by the Hand Surgery Society of the Chinese Medical Association, 3 fingers were in excellent and 2 in good. No obviouse affect on walking was found in all the patients.Conclusion:The free second toe joint composite tissue together with the great toe flap can be used to bridge the single segmental defect of a finger. It restores the blood supply to as well as the appearance of the distal finger, helps the recovery of the reconstructed distal finger. It is an ideal technique in the treatment of a severed distal segment of the finger.
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Objective To explore the operative method and effect of replantation of complex severed thumb with the pedicled flap from the rasceta area.Methods From March,2015 to March,2017,12 cases of complicated thumb injury were treated by retrograde transfer flap pedicled with the superficial palmar branch of the radial artery.All digital arteries defective with soft tissue defect,the area was 1.5 cm×3.0 cm to 5.5 cm ×7.0 cm.The wound of the wrist donor site was sutured directly.Postoperative followed-up was performed to review if the flap survival.Results There was 1 case of venous reflux disorder.After removal of some sutures,the symptoms were relieved.All other fingers survived successfully,and the flap survived completely.The donor site incision healed at Ⅰ stage.The followed-up period was 12-18 (average,13.5) months.The appearance of the thumb and flap was satisfactory,and the scar in the donor site was not obvious.The thumb function was evaluated according to the evaluation standard of thumb and finger reconstruction function of the Chinese society of medical surgery.Eight cases were excellent,3 cases were good,and 1 case was medium.Conclusion The pedicled flap from the rasceta area has the advantages of simple operation and reliable blood supply.It can reconstruct the defect vessels and repair the wound at the same time.It is a new method for replantation of complicated severed thumb.
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Objective To explore the method of replanting severed piercing finger micro tissue blocks. Methods From February, 2001 to October, 2016, 16 cases of severed piercing finger micro tissue blocks were re鄄planted with debridement. The trunk or branch of proper palmar digital artery was anastomosed. Vascular collocations were used such as venous arterialization when there was no anastomotic artery available. Regular postoperative fol鄄lowed-up was performed to observe the recovery of tissue survival, appearance, sensation of flap, and joint function. Results One case had partial epidermal necrosis, and healed after change of dressing.The finger-disconnected micro tissue blocks of other 15 cases survived well.After 6 months to 2 years of follow-up, the replanted micro tissue blocks were ruddy in color and recovered from S3 to S4. The appearance of the 16 fingers was good, and the function of joints was restored. Conclusion The finger-disconnected micro tissue blocks should be actively replanted. With skilled microsurgical techniques, the anastomosis of the arterial or venous artery will ensure the success of replantation and survived, as well as to restore good function and appearance.
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Objective@#To explore the method of replanting severed piercing finger micro tissue blocks.@*Methods@#From February, 2001 to October, 2016, 16 cases of severed piercing finger micro tissue blocks were replanted with debridement. The trunk or branch of proper palmar digital artery was anastomosed. Vascular collocations were used such as venous arterialization when there was no anastomotic artery available. Regular postoperative followed-up was performed to observe the recovery of tissue survival, appearance, sensation of flap, and joint function.@*Results@#One case had partial epidermal necrosis, and healed after change of dressing. The finger-disconnected micro tissue blocks of other 15 cases survived well. After 6 months to 2 years of follow-up, the replanted micro tissue blocks were ruddy in color and recovered from S3 to S4. The appearance of the 16 fingers was good, and the function of joints was restored.@*Conclusion@#The finger-disconnected micro tissue blocks should be actively replanted. With skilled microsurgical techniques, the anastomosis of the arterial or venous artery will ensure the success of replantation and survived, as well as to restore good function and appearance.
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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 the factors that induce constipation in bedridden patients undergoing replantation of severed finger and find countermeasures. Methods A retrospective investigation was carried out in 92 patients undergoing replantation of severed finger, their constipation and factors influencing constipation were recorded. Results 61 patients suffered from constipation in total 92 cases,the rate being 66.30%. 76 patients reduced food intake, and 59 cases presented constipation (the rate being 77.63%). Factors influencing constipation included being unaccustomed to defecate in bed (the rate that present with constipation being 87.09%),reluctant to trouble others(75.47%), side effects of drugs(55.56%) and lack of dietary knowledge (71.87%), decreasing food intake was closely bound up with constipation. Conclusions Proper psychological counseling, strengthening of health propaganda, comfortable facility for defecation, improved family support and oral food intake can significantly reduce the proportion of constipation and increase comfort degree of patients.
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Objective To discuss the methods and effects of replantation to treat complex thumb severance. Methods 56 cases of complex thumb severance combined with soft tissue defects were treated with simple vessel transplantation, veno flap transplantation, dorsal index digital island flap transplantation, digital artery transfer, transfer of radial index digital artery pedicled island flap, or veno arteriolization. The soft defects were repaired by the transfer of extensor index finger tendon and superficial ring finger flexor tendon. Results 50 cases survived and 6 cases failed, with the survival rate being 89%. 42 cases were followed up for 5 to 25 months. The function of the treated thumbs was assessed as excellent in 10, good in 25 and bad in 7. The excellent and good rate was 83%. Conclusion Complex thumb severance can be treated by unconventional replantation so as to achieve good effects.