Repair of degloving injury of distal thumb with innervated reversed dorsal digital artery island flap / 中华医学美学美容杂志

Objective:To investigate the clinical outcomes of homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve to repair degloving injury of distal thumb.Methods:From July 2016 to June 2019, a total of 15 cases (15 thumbs) with degloving injury of distal part were admitted to the Department of Hand Surgery, the Second Hospital of Tangshan. Nine males and six females were involved, with an average age of 49 years (range, 41 to 69 years). There were twist injury in eight cases and crush injury in seven cases, with four cases of distal phalanx fracture. The defect dimensions after debridement ranged from 3.5 cm×1.8 cm to 4.6 cm×2.4 cm, and the dimension of the flaps ranged from 3.8 cm×2.1 cm to 5.0 cm×2.7 cm. All defects were repaired using homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve. The survival, appearance and sensory recovery of the flaps and function of the injured fingers were observed at the follow-up after operation.Results:All the flaps survived without wound infection and blood supply disorder. The follow-up times ranged from 9 to 22 months (mean, 16 months). There was satisfactory appearance of the flaps with similar color and texture to the surrounding tissue. Fracture healing ranged from 4 to 6 weeks. At final follow-up, the values of static 2-PD test of the flaps ranged from 5 to 10 mm (mean, 7.8 mm). The results of range of motion of injured thumb joints were excellent in nine cases and good in five cases. There was slight linear scar left at the donor area of dorsal thumb.Conclusions:The innervated reversed dorsal digital artery island flap has a simple procedure and minimal donor-site cost, which is especially suitable for elderly patients who refuse to free toe transfers.

Repair of soft tissue defects at middle or distal part of 2nd ～ 5th finger and donor site with relaying reversed perforator flaps / 中华显微外科杂志

Objective To investigate the clinical effectiveness of the reversed flaps pedicled with lateral vas-cular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery for relaying repair of soft tissue defects at middle-distal part of the 2nd ～ 5th finger and donor site. Methods From June, 2014 to May, 2016, a total of 18 cases (11 male and 7 female) with soft tissue defects at middle-distal part of 2nd～5th fin-ger were treated with the reversed flap pedicled with lateral vascular chain of dorsal branch of digital artery. The donor site was repaired with the reversed flap pedicled with the perforating branch of the dorsal metacarpal artery. The aver-age age at the time of reconstruction was 41 years. The right hand was involved in 12 cases and the left in 6 cases. The etiologies of injury were avulsion (n=5) , crush (n=6), and saw-cut injury (n=7). There were 15 cases with soft tissue defect at the distal phalanx and 3 cases with loss of distal and middle phalanx. All these cases were exposed with bone or tendon. The defect size ranged from 1.0 cm × 1.8 cm to 2.0 cm × 3.0 cm. And the dimension of the re-versed flaps pedicled with lateral vascular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery ranged from 1.2 cm × 2.0 cm to 2.3 cm × 3.3 cm, and 1.4 cm × 2.3 cm to 2.6 cm × 3.6 cm, respec-tively. Postoperative follow-up was done termly. Results All flaps survived uneventfully with primary healing at donor site. The mean of followed-up time was 11 months (ranged from 6 to 15 months). The appearance and texture of the flaps were satisfactory and similar to the surrounding tissue. There was only some linear scar left at the dorsum of the palm. On the basis of the MHQ, 16 patients were strongly satisfied (score 5) with the appearance of the flap, and the remaining 2 patients was satisfied (score 4) with the appearance. The static 2-point discrimination of the flaps at the middle-distal part of 2nd～5th finger was 5-9 mm. Based on TAM assessment, the function of the injured finger was graded as excellent in 15 cases, good in 3 cases. Conclusion The relaying reversed flaps pedicled with lat-eral vascular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery can be applied for repair of soft tissue defects at middle-distal part of 2nd～5th finger and donor site with easy procedure, reliable blood supply, satisfactory results, good appearance as well as less complications at donor sites.

Dorsal digital advancement flaps vascularized with digital arteries for repair of finger pulp defect / 中华创伤杂志

Objective To investigate the effect of dorsal digital island advancement flaps accompanied with digital arteries in reconstruction of finger pulp defect.Methods The study enrolled 36 cases (43 fingers) of pulp soft tissue defect treated from October 2007 to July 2011.There were 25 males (30 fingers) and 1l females(13 fingers),at age of 12-62 years (mean 34.5 years).Causes of injury included crushing in 19 cases (16 fingers),squeezing in 13 (16 fingers) and cutting in 4 (5 fingers).The fingers involved were the index (11),the middle (18),the ring (9),and the little (5).All wounds revealed the exposed bone with defect area ranging from 1.2 cm × 1.0 cm to 2.6 cm × 2.0 cm.Dorsal digital island flaps accompanied with digital artery were used for finger reconstruction and sensation was restored by anastomosing to dorsal branch of digital nerve.Donor sites were closed using skin grafts.Results All flaps survived.Thirty-three cases (39 fingers) were followed up for 5-26 months (mean 14.5 months).The flaps revealed satisfactory appearance,soft texture and good elasticity.The injured fingers were pain-free.Two point discrimination was 5-8 mm (mean 6.7 mm).According to the upper limb function criteria formulated by Hand Surgery Branch of Chinese Medical Association,the results were excellent in 24 fingers,good in 13 fingers,and fair in 2 fingers,with the excellence rate of 95％.Conclusion Dorsal digital advancement island flap vascularized with digital artery is relatively the best for finger pulp coverage,for the procedure is easy and safe,with satisfactory result.

Modified super large dorsal metacarpal artery flap for reconstruction of circumferential fingertip avulsion / 中华创伤杂志

Objective To discuss the clinical outcome of the modified super large dorsal metacarpal artery flap in reconstruction of circumferential fingertip avulsion. Methods Twenty-four patients with circumferential fingertip avulsion were treated by the modified super large dorsal metacarpal artery flap from January 2004 to August 2008. There were six index fingers, 11 middle fingers, five ring fingers and two little fingers with surface defects beyond the distal interphalangeal joint and the distal degloving length ranged from 0.8 cm to 3.1 cm. Emergency operation was performed on 22 fingers and stage Ⅱ surgery was done for distal skin necrosis of two fingers. Results Twenty-one patients with 21 fingers were followed up for 6-28 months, which showed that all flaps survived, with satisfactory appearance and function, and that the point discrimination of flap was for 6-9 mm ( average 7.6 mm). Conclusion Modified super large dorsal metacarpal artery flap is an ideal method for reconstruction of the circumferential fingertip avulsion with advantages of easiness, convenience and short treatment period.