ABSTRACT
Objective:To explore the method and effect of aesthetic reconstruction of distal segment of finger with modified second toe nail flap while retains the full length of the second toe.Methods:From April 2018 to June 2020, 16 patients with degloving injury of distal segment of fingers were treated. The patients were 11 males and 5 females aged 18 to 45 years in an average of 29 years. All injuries were degloving injury of the distal segment of finger, including 5 index fingers, 7 middle fingers, 3 ring fingers and 1 little finger. The time from injury to operation was 0.5-3.0 hours, with an average of 1.5 hours. The second toe nail flap was used for the reconstruction. After the dorsal flap of the second toe was rotated to the plantar side of the foot, the donor site defect was repaired by a skin graft. The regular follow up reviews were carried out.Results:All 16 flaps survived except 1 flap had necrosis and underwent toe amputation of the distal segment of the second toe. All patients entered follow-up for 4-12 months, with an average of 5.7 months. The blood supply of all flaps was good. After the flaps having atrophied, they were equivalent to the diameter of the body of normal fingers with the TPD at 6.5(4-10) mm; All patients returned to work. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 13 cases were graded as excellent, 2 were good and 1 was fair.Conclusion:The techniques of modified second toe toenail flap in aesthetic reconstruction of the distal segment of a finger can effectively restore the length and aesthetic appearance of the affected finger, without sacrificing the donor toe. Clinical application of it should be promoted.
ABSTRACT
Objective:To summarise the clinical efficacy and surgical indications for free hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of distal thumb degloving injuries.Methods:From May 2009 to May 2021, a total of 24 patients (24 digits) with degloving injury of distal thumbs were treated in the Department of Hand and Microsurgery of Baoji Third Hospital. The flap was selected according to the patient's wishes and occupation. Of the 24 patients, 13 were repaired by free hallux toe nail flap transfer (group of hallux toe nail flap), and 11 were repaired by combining the proper palmar digital artery island flap of middle (ulnar side) and ring (radial side) fingers with the same volar common digital artery vascular pedicle (group of tile combined flap). Follow-up was performed at the 1st, 3rd, 6th,12th and 18th months after surgery respectively through outpatient clinic and telephone or WeChat interviews. The follow-ups focused on the appearance, colour, texture and two-point discrimination (TPD) of the flap, as well as thumb flexion, extension, opposition and grasping functions. Functional recovery evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the 24 flaps survived and all were included in the follow-up. The follow-up lasted 12-60 and 6-18 months, with an average of (18.5±0.5) months and (6.8±0.3) months in group of hallux toe nail flap and group of tile combined flap, respectively. Appearance of thumb body and function at the last follow-up showed: in the group of hallux toe nail flap, the nails, thumbtips and fine sensations were restored, with the TPD at 5-8 mm. The thumb flexion, extension, opposition and grasping functions were good. Apart from without nails and fingerprint, the flaps in the group of tile combined flap had good appearance and texture, and the protective feeling was restored with the TPD at 6-11 mm. The affected thumbs also recovered the basic functions of flexion, extension, opposition and grasping. According to the Trial Standard of Upper Limb Function Evaluation of the Chinese Medical Association Hand Surgery Society, 7 cases were excellent, 5 cases were good, and 1 case was poor in the group of hallux toe nail flap. In the group of tile combined flap, 3 cases were in excellent, 5 in good, and 3 in poor. Appearance of flaps (such as nails and thumbtip fingerprint), fine sensory recovery, and the accuracy and stability of the grasping function, the group of hallux toe nail flap was significantly better than that of the group of tile combined flap. There was no functional impact on the donor site.Conclusion:Both types of flap are classic surgical procedures for repair of distal thumb degloving injury. In order to meet the individual requirement and to improve the efficacy of the treatment, such as for those who have high expectation for digit restoration, especially those who are young with aesthetical or professional requirement, free hallux toe nail flap repair is used to restore the perfect shape and function. And for those who are reluctant to sacrifice their toes or for the middle-aged and elderly people who do not have high expectation for the shape of thumb, a tile combined flap repair is used to restore thumb function.
ABSTRACT
Objective To explore the wound healing of semi-toe nail flap donor site after transplantation. Methods To repair small wounds,on 13 toes the first metatarsal dorsal flaps were applied,and on 7 toes the second toe digital flaps were applied.While,to repair large wounds,free flaps were applied,including foot inside flaps on 3 toes,peroneal artery perforator flaps on 5 toes,tarsal lateral artery flaps on 2 toes,and phil bowel artery inside branch flaps on 3 toes.Wounds remaining on semi-toe nail flaps of 7 toes were all covered with fibular island flaps of the first toes. Results Twenty cases were followed up,and the rang between 6 months to 5 years.The nail margin was exposed out of the lateral flaps in 2 cases.The first toes and the second toes appeared nearly normal in the other 18 cases.The flaps appeared smooth,flexible appearance with nice color and no ulceration.Seven cases applied with free flaps recovered protective sensibility with no complaint. Conclusion To cover wounds on semi-toe nail flaps of the first toes and the second toes with flaps is an ideal treatment method.The method of free flap transplantation is superior to vascular pedicle flap graft.
ABSTRACT
ObjectiveTo explore methods of donor repair of the great toe-nail flap in finger reconstruction surgery.MethodsFrom December 1998 to December 2010, various kinds of flaps were used in 511 donor sites to repair the great toe-nail flaps,including:32 dorsal pedal artery flaps;twenty-four first dorsal metatarsal artery flaps;twenty-one second dorsal metatarsal artery flaps;forteen anterior malleolar flaps;seventeen medial tarsal artery flaps;seventy-nine lateral tarsal artery flaps;one hundred and six plantar metatarsal flaps,seventy-nine flaps from second toe;fifteen flaps from mid/lower leg and 124 freed flaps.ResultsAfter postoperative 6 months to 11 years of follow-up, repaired donor sites of great toe-flaps all survived successfully,with ideal outlook and function.ConclusionThere are many kinds of methods for donor site repair of the great toe-nail flap,and each kind of method has its own advantages and disadvantages. Among these flaps, plantar pedal artery flap and free groin flap are amony the best ones.