APPLICATION OF VENOUS Flow-through FLAP IN FINGER REPLANTATION WITH CIRCULARITY SOFT TISSUE DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHENGDawei ¹ , LIZhangcan ¹ , XULi ¹ , ZHANGXuyang ¹ , SHIRongjian ¹ , SUNFeng ¹ , SHOUKuishui ²

1. Department of Hand and Foot Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221004, P. R. China;
2. Department of Hand Surgery, Wuxi Hand Surgery Hospital;

Corresponding author：

ZHENGDawei, Email: davyzheng93006@163.com

Keywords：

Venous Flow-through flap; Circularity soft tissue defect; Replantation of severed finger

DOI：

10.7507/1002-1892.20140215

Video：

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Objective To investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect. Methods Between January 2010 and December 2012,11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps.There were 8 males and 3 females,aged 18-42 years (mean,24.6 years).The cause of injury was squeeze injury in 6 cases,crush injury in 3 cases,and strangulation in 2 cases.Combined injuries included nerve defect in 3 cases (1.0,2.0,and 3.5 cm in length),and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width,was 1/2-1 finger circumference in length,and was 2.0 cm×1.0 cm to 7.0 cm×4.5 cm in size.Six cases had complete circular defect (both finger artery and vein defects),and 5 cases had incomplete circular defect (only finger artery defect),and vascular defect was 1.0-4.5 cm in length.The time from injury to operation was 1.5-4.5 hours. Results Venous crisis occurred in 1 case at 2 days after operation,was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously.The other 6 flaps and replanted fingers survived completely,with primary healing of incision.Ten cases were followed up 12-18 months (mean,15.5 months).Only a linear scar was seen at the donor sites,with no functional limitation.The flaps had similar color and texture to adjacent skin.The two-point discrimination was 6.5-13.0 mm (mean,8.6 mm).According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,the results were excellent in 6 cases,good in 3 cases,and poor in 1 case at last follow-up,and the excellent and good rate was 90%. Conclusion Venous Flow-through flap can repair both vascular defect and soft tissue defect,so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.

Citation： ZHENGDawei, LIZhangcan, XULi, ZHANGXuyang, SHIRongjian, SUNFeng, SHOUKuishui. APPLICATION OF VENOUS Flow-through FLAP IN FINGER REPLANTATION WITH CIRCULARITY SOFT TISSUE DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 977-980. doi: 10.7507/1002-1892.20140215 Copy

1.	王增涛,蔡锦方,张成进,等.趾C形皮瓣修复手指环形组织缺损.中华显微外科杂志,2001,24(2):88-90.
2.	田万成.断指再植30年进展.中华显微外科杂志,1997,20(3):180-182.
3.	田秀全,石理水,樊秋云.足部双叶皮瓣移植修复拇指环形缺损.实用手外科杂志,2008,22(2):107.
4.	潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3):130-135.
5.	李锦永,李清秀,崔永光,等.复杂性断指再植.中华显微外科杂志,1996,19(4):296-297.
6.	李忠,劳克诚.联合微型静脉皮瓣修复手指环形组织缺损11例.实用医药杂志,2007,24(5):605.
7.	李涛,陈振兵,丛晓斌,等.邻指指动脉Flow-through皮瓣桥接断指血运的临床应用.中华显微外科杂志,2014,37(1):10-13.
8.	Nakayama Y,Soeda S,Kasai Y.Flaps nourished by arterial inflow through the venous system:an experimental investigation.Plast Reconstr Surg,1981,67(3):328-334.
9.	李瑞华,阚世廉,李明新.动脉化静脉皮瓣急诊修复手指软组织缺损.中国修复重建外科杂志,2008,22(7):797-799.
10.	孙文海,王增涛,仇申强,等.足底内侧静脉皮瓣修复指掌侧软组织缺损.中国修复重建外科杂志,2010,24(1):50-52.
11.	郑大伟,侯威,许立,等.游离静脉皮瓣在复杂性断指再植中的应用.中国修复重建外科杂志,2012,26(10):1266-1268.
12.	Devansh S.Lateral thigh free flap with flow-through vascular pedicle.Ann Plast Surg,2011,67(1):44-48.
13.	Haddock MC,Creagh T,Sivarajanlp V.Double-free,flow-through flap reconstruction for complex scalp defects:case report.Microsurgery,2011,31(4):327-330.
14.	Brooks D,Buntic RF,Taylor C.Use of the venous flap for salvage of difficult ring avulsion injuries.Microsurgery,2008,28(6):397-402.
15.	Lin YH,Jeng CH,Hsieh CH,et al.Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton:a case report.Microsurgery,2010,30(6):469-471.
16.	George P,DeJesus RA.Venous flow-through flap reconstruction following severe finger wound infection:case report.J Reconstr Microsurg,2009,25(4):267-269.
17.	Woo SH,Kim KC,Lee GJ,et al.A retrospective analysis of 154 arterialized venous flaps for hand reconstruction:an 11-year experience.Plast Reconstr Surg,2007,119(6):1823-1838.
18.	Hýza P,Veselý J,Novák P,et al.Arterialized venous free flaps-a reconstructive alternative for large dorsal digital defects.Acta Chir Plast,2008,50(2):43-50.
19.	Lin YT,Henry SL,Lin CH,et al.The shunt-restricted arterialized venous flap for hand/digit reconstruction:Enhanced perfusion,decreased congestion,and improved reliability.J Trauma,2010,69(2):399-404.
20.	Yan H,Brooks D,Ladner R,et al.Arterialized venous flaps:a review of the literature.Microsurgery,2010,30(6):472-478.
21.	Goldschlager R,Rozen WM,Ting JW,et al.The nomenclature of venous flow-through flaps:updated classification and review of the literature.Microsurgery,2012,32(6):497-501.

1. 王增涛,蔡锦方,张成进,等.趾C形皮瓣修复手指环形组织缺损.中华显微外科杂志,2001,24(2):88-90.
2. 田万成.断指再植30年进展.中华显微外科杂志,1997,20(3):180-182.
3. 田秀全,石理水,樊秋云.足部双叶皮瓣移植修复拇指环形缺损.实用手外科杂志,2008,22(2):107.
4. 潘达德,顾玉东,侍德,等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志,2000,16(3):130-135.
5. 李锦永,李清秀,崔永光,等.复杂性断指再植.中华显微外科杂志,1996,19(4):296-297.
6. 李忠,劳克诚.联合微型静脉皮瓣修复手指环形组织缺损11例.实用医药杂志,2007,24(5):605.
7. 李涛,陈振兵,丛晓斌,等.邻指指动脉Flow-through皮瓣桥接断指血运的临床应用.中华显微外科杂志,2014,37(1):10-13.
8. Nakayama Y,Soeda S,Kasai Y.Flaps nourished by arterial inflow through the venous system:an experimental investigation.Plast Reconstr Surg,1981,67(3):328-334.
9. 李瑞华,阚世廉,李明新.动脉化静脉皮瓣急诊修复手指软组织缺损.中国修复重建外科杂志,2008,22(7):797-799.
10. 孙文海,王增涛,仇申强,等.足底内侧静脉皮瓣修复指掌侧软组织缺损.中国修复重建外科杂志,2010,24(1):50-52.
11. 郑大伟,侯威,许立,等.游离静脉皮瓣在复杂性断指再植中的应用.中国修复重建外科杂志,2012,26(10):1266-1268.
12. Devansh S.Lateral thigh free flap with flow-through vascular pedicle.Ann Plast Surg,2011,67(1):44-48.
13. Haddock MC,Creagh T,Sivarajanlp V.Double-free,flow-through flap reconstruction for complex scalp defects:case report.Microsurgery,2011,31(4):327-330.
14. Brooks D,Buntic RF,Taylor C.Use of the venous flap for salvage of difficult ring avulsion injuries.Microsurgery,2008,28(6):397-402.
15. Lin YH,Jeng CH,Hsieh CH,et al.Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton:a case report.Microsurgery,2010,30(6):469-471.
16. George P,DeJesus RA.Venous flow-through flap reconstruction following severe finger wound infection:case report.J Reconstr Microsurg,2009,25(4):267-269.
17. Woo SH,Kim KC,Lee GJ,et al.A retrospective analysis of 154 arterialized venous flaps for hand reconstruction:an 11-year experience.Plast Reconstr Surg,2007,119(6):1823-1838.
18. Hýza P,Veselý J,Novák P,et al.Arterialized venous free flaps-a reconstructive alternative for large dorsal digital defects.Acta Chir Plast,2008,50(2):43-50.
19. Lin YT,Henry SL,Lin CH,et al.The shunt-restricted arterialized venous flap for hand/digit reconstruction:Enhanced perfusion,decreased congestion,and improved reliability.J Trauma,2010,69(2):399-404.
20. Yan H,Brooks D,Ladner R,et al.Arterialized venous flaps:a review of the literature.Microsurgery,2010,30(6):472-478.
21. Goldschlager R,Rozen WM,Ting JW,et al.The nomenclature of venous flow-through flaps:updated classification and review of the literature.Microsurgery,2012,32(6):497-501.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF VENOUS Flow-through FLAP IN FINGER REPLANTATION WITH CIRCULARITY SOFT TISSUE DEFECT

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