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Objective To investigate the treatment of outcomes of repairing soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects.Methods From January,2014 to June,2016,7 patients(4 males and 3 females.Patients'age ranged from 18 to 45 years,with an average of 28.5 years) with soft tissue defects on the palmar side of the proximal and middle phalanx of the fingers accompanied by proper digital artery and nerve defects were treated by first dorsal metatarsal artery Flow-through flap,application of color Doppler ultrasound was used in the detection of vascular type before operation.The flap area was from 2.0 cm×2.5 cm to 3.5 cm×5.5 cm.All the donor site of the flap were sutured directly.The patients were followed-up in 1 month,3 months,6 months,12 months,24 months after the surgery,and the results were evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association.Results All flaps survived.These cases were followed-up for 6 to 24 months,average 12 months.All the flaps got satisfactory appearance and good sense function,and 2-PD of the flap averaged 7 mm,ranging from 6 mm to 12 mm.All injured fingers got satisfactory appearance and good sense function,2-PD of the injured fingers averaged 8 mm,ranging from 6 to 15 mm.The donor site incision healed well no obvious scar hyperplasia,good function.Conclusion Application of the first dorsal metatarsal artery Flow-through flap to reconstruct soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects,can achieve good clinical effects.This method can restore the appearance,blood supply and sensation of the injured finger.
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Objective Retrospectively investigate the application of anterolateral thigh flow-through flap in reconstruction of the extremities,to estimate its role and characteriscts.Methods From March,2010 to January,2016,anterolateral thigh flow-through flap was performed for reconstruction of the extremities in 87 patients (56 males,and 31 females).Patient ages ranged from 13 to 68 years,average of 34.4 years.Of all cases,there were 37 legs,21 ankles or foots,1 arm,19 forearms,and 9 hands.The role and result of anterolateral thigh flow-through flap was analyzed retrospectively.Results The result showed that when anterolateral thigh flow-through flap was transferred,which simutaneously played various roles as follows:①rebuilding main vascular defect,to revascularise the distal limb.② preserving recipient vessels,to prevent flow impaired.③rebulding recepient vessel defect.④ protecting vascular anastomosis and preserving recipient flow simultaneously.⑤avoiding the dilemma of end-to-side anastomosis when recipient vessels is deep.⑥ balancing blood flow,the blood supply of the flap was more stable.⑦ linking another tissue in a series fashion,to achieve complex reconstruction.Vascular compromise occurred in 3 cases after surgery,total necrosis occurred in 1 case and partial necrosis in 1 case after reexploration.One case presented deep infection and secondary with renal failure,and received amputation.Local infection presented in 3 cases,wound dehiscence in 2 cases.All the other flaps survivled uneventfully,and its texture and color was normal.In donor site,local infection occurred in 1 case,wound dehiscence in 2 cases.Conclusion Anterolateral thigh flow-through flap has function of many sided reconstruction,which is able to play a vital role in reconstruction of the extremities.
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Objective To investigate the methods and clinical effects of flow-through posterior interrosseous artery flaps for reconstructing digital wounds combined with artery injury.Methods From December 2011 to September 2013,11 patients with traumatic digital defect combined with artery injury were repaired with flow-through posterior interrosseous artery flaps.Flap aesthetic satisfaction was assessed using questionnaires; flaps were tested for pain and touch sensation,temperature perception,and two-point discrimination; finger activity was detect using the total active movement (TAM) ratio of the injured and uninjured side.Results All flaps and injured fingers survived.Wounds healed by the first intension.Nine patients were followed up for 12-24 months.Two-point discrimination of the flaps recovered at postoperative 6 months and averaged (9.7 ± 2.1) mm at postoperative 12 months,with S3 +grade in sensation evaluation.TAM ratio of the injured and uninjured side was 0.85 ±0.17.All patients expressed the satisfaction to flap appearance.Conclusions Flow-through posterior interrosseous artery flaps are safe and effective to cover digital wounds and restore blood circulation.The technique improves the clinical application of perforator flaps.
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Objective To investigate the clinical application of neighboring digital artery flow-through flaps for one-staged skin coverage and revascularisation after severe finger injuries.Methods From May 2008 to July 2010,there were ischemic fingers had severe injuries,aged 19 to 52 years old,which were male in 5 cases,female in 2 cases,with skin and arterier defected.One-staged coverage and revascularisation of traumatised fingers were used with neighboring digital artery flow-through flaps.Functional exercise and physical therapy were done 3 weeks later.All cases had more than 12 months' fellowed-up periods.The sensibility testing,Questionnaire of the flap aesthetic satisfactory and TAM evaluations were all performed in all patients.All the results were measured and evaluated.Results All flaps survived completely and digit blood circulations were good in 7 patients.The flaps had good appearance and aesthetic satisfactory (100％).At 12 months after operations,the pain and touch perception reinnervated until 6 months and two-point discrimination testing were 6.1 to 9.6 mm,mean was (7.1 ± 1.3) mm,and the flap sensibility assessment were S3 * and TAM evaluation ratio were 0.81 ±0.16.Conclution Neighboring digital artery flap ideally suited as a thin and pliable flow-through flap in digital replantation/revascularization.It is helpful for salvage of the ischemic fingers after injury with skin and arteries defects.