Modified rectangle cross-finger flap to repair degloved avulsion of fingertip / 中华骨科杂志

ABSTRACT

Objective To investigate the operative procedure and the clinical result of the modified rectangle cross-finger flap based on the dorsal branches in the middle phalange to repair degloved avulsion of fingertip.Methods From January 2006 to March 2010,26 patients with the avulsions of fingertip were treated by the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange of adjacent finger.There were 21 men and 5 women,with an average age of 31.6 years(range,17-56 years).Fourteen cases were crushed by machine,8 cases were pressed and 4 cases were tied.There were 8 index fingers,9 long fingers,4 ring fingers and 5 little fingers.The length of the avulsion was 1.1-2.6 cm.The flap was harvested from the dorsal of contiguous digital of their middle and proximal segment.The both dorsal branches of the both proper palmar digital nerves were cut off and were anatomized with the nerve end of the injured digit.The area of flaps ranged from 3.6 cm×2.3 cm-6.5 cm×3.2 cm.The donors were closed by skin graft.Results The pedicels were cut when 13-23 d after operation.Twenty-five patients were followed up for 6-28 months(mean,16.3 months).All flaps survived with satisfactory appearance,sensation and function.All flaps and donors were primary healing.Two point discrimination was 6-9 mm with an average of 7.8 mm.The postoperative outcomes were evaluated by the total active movement.The results were excellent in 17fingers,good in 7,and fair in 1.The rate of excellent and good was 96%.Conclusion The treatment of degloved avulsion of fingertip with the modified rectangle cross-finger flap based on the dorsal branch in the middle phalange is recommendable.The operative procedure of harvesting the flap is simple.There is enough blood to supply the flap and the surviving rate is high.The postoperative function of the injured hand can be recovered satisfactorily.The figure of flap is well and the sense of flap is sensitive.The technique can be operated in the last 4 fingers without thumb.