Repairing degloving injury of fingers by transplantation of ateriolized venous network flap with sensory nerve for six cases (7 fingers). The flaps were all gotsurvived. The procedure of the operation was performed as following: 3～5 supperficial veins and the medial or lateral cutaneous nerve were separated on the palmar side of the forearm as pedicle. According to the defect, the corresponding flaps was designed and was transferred to the injuried finger. Anastomosed the veins with the two digital arteries and veins. Anastomosed the cutaneous nerve with the digital nerves. The patients were followed up for two years. The flaps were soft and wearresisting. The joint movements of the fingers were normal. The twopoints discrimination was 5 to 10mm. The contour of the fingers was satisfactory. The procedure has the following advantages: 1. carried out one operation; 2. good sensation, 3. good appearance and satisfactory function. The indications and factors affecting the survival of the flap were discussed.
OBJECTIVE: To investigate the clinical effects of the microsurgical treatment for the skin-degloving injury of the whole hand or foot. METHODS: From March 1984 to October 2001, we treated 6 cases of skin-degloving injury of the whole hand and foot. In 2 cases of skin-degloving hands, one was treated with free great omentum transplantation plus skin graft, the other with pedical abdominal S-shaped skin flap as well as mid-thick skin graft. In 4 cases of skin-degloving injury of the foot, 2 cases was repaired with free latissimus dosi musculocutaneous flap, 1 case with distall-based lateral skin flap of the leg and 1 case with free tensor fasciae latae muscle flap. The flap size ranged from 7 cm x 9 cm to 22 cm x 15 cm. One case was operated on the emergency stage, the other 5 cases on the delayed stage. The delayed time ranged from 2 to 14 days with an average of 6.6 days. RESULTS: All the flaps survived. After 1-2 year follow-up, the appearance and function of the hand and the foot were good. CONCLUSION: Microsurgery technique in repairing skin-degloving injury of the whole hand and foot can achieve good results. The keys to success are thorough debridement of the recipient area, appropriate selection of the donor site, good vascular anastomosis and active postoperative rehabilitation.
Objective To investigate the effectiveness of reverse island flaps of digital artery parallel for repairing degloved injuries of the fingerti p. Methods Between June 2008 and January 2010, 13 cases of degloved injuries of the fingertip were treated. There were 8 males and 5 females with an average age of 34 years (range, 19-62 years). The causes of injuries were as follow: impact and press injury in 5 cases, wringer injury in 7 cases, and crush injury in 1 case. The injured fingers were comprised of index finger in 6 cases, middle finger in 4 cases, ring finger in 2 cases, and l ittle finger in 1 case. The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm to 3.0 cm × 2.5 cm. Three cases compl icated by fracture of thedistal phalanx, 1 case by rupture of the insertion of extensor tendon, and 1 case by rupture of the insertion of flexor tendon. The average time from injure to surgery was 4 hours (range, 1 hour and 30 minutes-12 hours). Two neighboring skin flaps located in the same course of digital artery were adopted to repair defect of the fingertip. The size of proximal skin flap ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm and the size of distal skin flap ranged from 1.1 cm × 1.0 cm to 1.5 cm × 1.3 cm. The free skin grafts were used to repair the donor sites. Results Circulation crisis occurred in 1 case at 2 hours after operation and was el iminated by interval disconnecting. The other flaps and skin grafts survived and the wounds healed by first intention. The patients were followed up 6-18 months (mean, 10 months). All flaps presented the satisfactory appearance and texture, and the flexion and extension function of wounded fingers recovered to normal. Two-point discrimination ranged from 7 to 11 mm at last follow-up. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion Based on the anatomical features of communicating branches of distal interphalangeal joint, two neighboring flaps located in the same course of digital artery are adopted to repair soft tissue defect of the fingertip. This surgical method is a simple and effective method.
ObjectiveTo investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs. MethodsBetween August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years (mean, 32 years). The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts. ResultsAll of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years (mean, 23 months). The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S3, and the mean two-point discrimination of the pulp was 6 mm (range, 4-7 mm). According to total active movement (TAM) system, the function of the thumbs was excellent in 5 cases and good in 1 case. ConclusionA combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a degloved thumb.
Objective?To investigate the surgical method and clinical efficacy of repairing whole-hand destructive injury or hand degloving injury with the transplant of pedis compound free flap.?Methods?From February 2003 to June 2008, 21 patients with whole-hand destructive injury or hand degloving injury were treated, including 15 males and 6 females aged 18-45 years old (average 25 years old). The injury was caused by punching machine crush in 10 cases, roller crush in 7 cases, and imprinter crush in 4 cases. The time between injury and operation was 1-9 hours. Eleven cases had the skin-degloving injury of the whole hand, while the other 10 cases had the proximal palm injury combined with dorsal or palmar skin and soft tissue defect. After debridement, the size of wound was 9 cm × 7 cm - 15 cm × 10 cm in the dorsal aspect and 10 cm × 7 cm -16 cm × 10 cm in the palmar aspect. The defect was repaired by the thumbnail flap of dorsalis pedis flap and the second toenail flap of dorsalis pedis flap in 5 cases, the thumbnail flap of dorsalis pedis flap and the second toe with dorsalis pedis flap in 4 cases, and bilateral second toe with dorsalis pedis flap in 12 cases. The flap area harvested during operation ranged from 6 cm × 5 cm to 16 cm × 11 cm. Three fingers were constructed in 2 cases and two fingers in 19 cases. Distal interphalangeal joint toe amputation was conducted in the thumbnail flap donor site, metatarsophalangeal joint toe amputation was performed in the second toenail flap donor site, and full-thickness skin grafting was conducted in the abdomen.?Results?At 7 days after operation, the index finger in 1 case repaired by the second toenail flap suffered from necrosis and received amputation, 1 case suffered from partial necrosis of distal dorsalis pedis flap and recovered after dressing change, and the rest 42 tissue flaps survived. Forty-three out of 44 reconstructed fingers survived. All the wounds healed by first intention. At 2 weeks after operation, 2 cases had partial necrosis of the donor site flap and underwent secondary skin grafting after dressing change, the rest skin grafts survived, and all the wounds healed by first intention. Nineteen cases were followed up for 6-36 months (average 11 months). The flaps of palm and dorsum of hand showed no swelling, the reconstructed fingers had a satisfactory appearance and performed such functions as grabbing, grasping, and nipping. The sensory of the flaps and the reconstructed fingers recovered to S2-S4 grade. The donor site on the dorsum of the foot had no obvious scar contracture, without obvious influence on walking.?Conclusion?For the whole-hand destructive injury or hand degloving injury, the method of transplanting pedis compound free flap can repair the defect in the hand and reconstruct the function of the injured hand partially. It is an effective treatment method.
OBJECTIVE: To explore a new surgical management of multiple fingers degloving injury. METHODS: In 1994 to 1997, 47 cases with multiple fingers degloving injury were sutured by two reverse "s"-type skin flaps on abdominal flank. RESULTS: The skin flaps in 46 cases survived and the wounds obtained primary heal. CONCLUSION: The application of abdominal flank "s"-type skin flap is reliable and convenient in the treatment of multiple fingers degloving injury.