Combined transfer of the free second toe dorsal wrap around flap and fibula side flap of great toe to repair degloving injury of the single finger / 中华显微外科杂志

ABSTRACT

Objective To provide the new method for repairing degloving injury of the single finger.Methods From August 2007 to June 2010,eleven patients were repaired with the second free toe dorsal wrap around flap and fibula side flap of great toe.Patients including 9 men and 2 women.The mean age were 31 years(17-49 years).The finger including 6 index fingers,two middle fingers and 3 ring fingers,in which 4 patients were type I and 7 patients were type Ⅱ.All of them were emergency debridement VSD closed negative pressure attraction,surgical repair in 3-5 days after injury.The plantar digital nerve in the second free toe dorsal wrap around flap and fibula side flap of great toe with the digital nerve of the stump by end-to-end nerve anastomosis.The donor sites were covered with a free flap.Results All of 11 flaps survived,but 2 cases developed partial native second toe skin grafting necrosis,by dressing healed,one case of phalanges exposed through survival skin,the part of the exposed phalanx healed after surgical cut.All the 11 patients were followed up from 3 monthes to 3 years.The flaps survived completely with satisfactory cosmetic results and good sensibility.The sensation recovery was reached above S3.The great toe fibular flap for repair of finger pulp full,two-point discrimination was 6-9 mm,the mean was 7.0 mm.Finger flexion function by finger total activity (TAM) score assessment,excellent 9 cases,good 2 cases.Conclusion Transfer of the second free toe dorsal wrap around flap and fibula side flap of great toe to repair degloving injury of the single finger is an ideal method of treatment.