RESUMEN
Objective To evaluate the surgical methods and clinical effects of the reconstruction of soft tissue defect in distal thumbwith dorsal thumb neurocutaneous vascular flap.Methods From January,2014 to December,2016,32 patients with soft tissue defects of distal thumb were repaired with dorsal thumb neurocutaneous vascular flaps,including left thumbs in 11 cases and right thumbs in 21 cases.They were including 7 cases of nail bed defects,9 cases of pulp defects under nails,16 cases ofthe defects of tips or stump of fingers;skin and soft tissue defects range of 1.5 cm×1.0 cm-3.5 cm×3.2 cm;Flap cutting areas range of 2.0 cm×l.5 cm-4.0 cm×3.5 cm.If the donor areas could be sutured directly,be sutured;if they could not,be covered with intermediate split thickness skin grafts.All patients were followed up when they were reviewed in outpatient department,and to be evaluated the shape,texture,sensation,flexion and extension function,and donor site of the flaps.Results One case of flaps blood circulation disordereddue to tight suture,and eased after the removal of part of the sutures;One case of flaps atrophied,and the phalangette was exposed after 3 months,so we removed the end part of bone and the wound was closed;other flaps were survived,with primary wound healing.In the total 32 patients,they were followed up range of 3 to 36 months,with an average of 12 months.Eighteen cases were followed up at least 6 months,which were 4 of the 7 cases of nail bed defects,5 of the 9 cases of pulp defects under nail and 9 of the 16 cases of the defects of tip or stump of fingers.The appearances and textures of flaps were good,protective sensations were restored,and skin flap two-point discriminationswere 8-10 mm.According to the Trial Standard for Evaluation of Upper Limb Function of Chinese Society of Hand Surgery,it was excellent in 11 cases,good in 17 cases and moderate in 4 cases,with the excellent and good rate of 87.5％.Conclusion It has advantages of simple operation,low risk,high success rate and satisfactory curative effects of the use of dorsal thumb neurocutaneous vascular flap for repair of distal thumb defect of skin and soft tissue.It is not only suitable for the hospital with good technical and equipment,but also suitable for the primary hospital.
RESUMEN
Objective To investigate the method and effectiveness of the digital artery series and parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger Methods Between September 2008 and July 2012,the finger artery series retrograde island flaps tiled in the repair of finger degloving injury in 13 cases,repair of adjacent finger tip degloving injury in 11 cases; 8 cases of degloved injuries of the fingertip were tiled with the digital artery parallel island flap from ulnaris middle finger and radialis ring finger of arteria digitalis communis pedicled which were from the same palm side.The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm-7.2 cm ×5.5 cm,gutted flap minimum ranged from 1.1 cm × 1.0cm-1.5 cm × 1.3cm,and the maximum ranged from 3.0 cm × 2.2 cm-5.5 cm × 4.5 cm.The donor sites were repaired with the intermediate split thickness free skin grafts and performed with pressure dressing.Results The group of 32 cases,in 1 case the flap vasospasm occurred in operation of free process,the symptoms disappeared after local application of papaverine and hot compress ; 1 case of flap occurred disturbance of blood circulation after operation because of tight suturing for pedicle,the symptoms relieved after removing the stitches at intervals; 2 cases blisters appeared after operation,disappeared after a week.All skin flaps were survived,incision and skin graft donor sites healed by first intention.Twenty patients were followed-up from 6 to 12 months after operation.All flaps presented the satisfactory appearance and texture,recovered protective feeling.At last follow-up,the two-point discrimination was 7 to 10mm,and the flexion and extension function of wounded fingers recovered to normal.According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association,there were excellent in 19 cases,good in 10 cases,and moderate in 3 cases.No significant loss to the donor shape and function.Conclusion The surgery by adopted the digital artery series or parallel of island flap for repairing degloved injuries of the fingertip of thumb or adjacent finger,not only has the advantages of simpleness,safety and reliability,but also can satisfy the patients who aren't willing to accept or because of physical reasons can't accept the treatment of abdominal skin tube or nail flap from hallux toe,which performs in both high-end and low level hospitals,and deserves of general application.