Coverage of the thumb soft tissue defect by five kinds of flaps / 中华骨科杂志

ABSTRACT

Objective To explore the curative effect and indication in coverage of the thumb soft tissue defect by five kinds of minute flaps. Methods From January 1998 to March 2003, 52 cases with skin and soft tissue defect of the thumb were treated by five different kinds of flaps 5 underwent the wrapping flap with nail from the big toe, 15 with the reversible thumb dorso-ulnar artery island flap, 10 with the thenar flap, 8 with the lateral digital island flap, 14 with the index finger dorsal island flap. There were 40 males and 12 females, aged from 17 to 35 years (average, 25 years). The maximum area of the repair flap was 5.0 cm?2.5 cm, and the minimum area was 2.0 cm?1.5 cm. Results All flaps survived. After 6 to 36 months postoperative follow-up, with an average of 20 months. The blood supply and texture of the flaps were excellent, their outer aspect and function were satisfactory. Among 46 cases of flaps with their proper or connecting nerves, the average distance of the two-point discrimination was 5.8 mm in the wrapping flap with nail from the big toe, 8.5 mm in the reversible thumb dorso-ulnar artery island flap, 7.0 mm in the thenar flap, 6.2 mm in the lateral digital island flap, 8.8 mm in the index finger dorsal island flap. Of the 6 cases that the nerves were not connected, the healed flaps had only the pain and touch sensation, the two-point discrimination was poorly recovered. Conclusion The five kinds of flaps are safe and reliable for repairing thumb soft tissue defect, among which the wrapping flap with nail from the big toe and the lateral digital island flap have the advantage of the best sensation recovery, the reversible thumb dorso-ulnar artery island flap and the thenar flap are easy to perform with minimum damage. Better curative effect can be obtained by choosing different flaps according to the site of tissue defect.