Since 1992, the retrograde island skin flap with its pedicle containing the arteria pollicis dorsalis was used to repair 6 cases of the fingertip defects and the results were successful. The skin measured from 1.5cm x 2cm to 4cm x 3.5cm. From the followup, the external appearance of the thumbs looked nice, no limitation of joint motions was noticed and the pain sensation was recovered. The major improvement of this operation was that the donor skin was chosen from the dorsum of the first and second metacarpal bones, thus it was not necessary to divide the tendon of the extensor pollicis brevis, so that the operative procedure was simple and the postoperative functional recovery was rapid.
Objective To investigate the operative method and cl inical efficacy of repairing fingertip defect with modified reverse homodigital artery island flap. Methods From March 2000 to September 2006, 18 cases (24 fingers) of fingertip defect were treated, including 12 males and 6 females aged 18-53 years (mean 29 years). Defect was caused by crush injuries in 12 cases, by avulsion injury in 3 cases, by twist injury in 2 cases and by incised injury in 1 case. The time from injury tooperation was 2-8 hours (mean 4 hours). The location were index fingers (3 fingers), middle fingers (4 fingers) and ring fingers (17 fingers). The defects of soft tissue were 1.9 cm × 1.7 cm to 2.4 cm × 1.9 cm in size, the reverse homodigital artery island flaps were from 2.0 cm × 1.5 cm to 2.5 cm × 2.0 cm in size. The donor site was repaired with dumped skin grafting(3 cases) and with skin grafting from medial area of planta pedis (15 cases). Results Skin flaps and skin grafting of all the 24 fingers survived after operation. All incisions and donor sites healed by first intention. Sixteen patients (22 fingers) were followed up for 1-5 years (mean 3.2 years).The appearance and function of the flaps were all satisfactory. Two-point discriminations of flaps ranged from 4.5 mm to 6.3 mm. According to the total active movement/total passive movement assessment criteria, the results were excellent in 20 fingers and good in 2 fingers; and the excellent and good rate was 100%. The circumference of donor site was 2.0-3.5 mm shorter than that of normal side. The two-point discriminations of donor site was 7.8-10.5 mm. Conclusion Repairing defect of fingertip with modified reverse homodigital artery island flap can provide good texture and contour matching the recipient area, good function and l ittle trauma at donor site.
To investigate an effective method in clinical application of using different kinds of skin flaps for repair of the finger deep burns. Methods The groin skin flap, the paraumbilical skin flap, the volar digital advancement flap, the island flap from the dorsum of the index finger, the lateral digital neurovascular island flap, and the island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum were employed to repair 157 fingers in 101 patients (78 males, 23 females, aged 12-56 years, averaged 34.6 years) from January 1997 to December 2006. Of the 101patients, 37 had a deep partial thickness burn involving 59 fingers, and 64 hada full thickness burn involving 98 fingers. The soft tissue defects ranged in area from 1.0 cm×1.0 cm to 6.5 cm×6.0 cm. The interval between the injury and the operation was 4 hours to 5 days in 89 patients, and 18 to 27 days in the other 12 patients who also had infected wounds. The flaps ranged in size from 1.2 cm×1.2 cm to 7.8 cm×6.5 cm. The donor site was directly sutured in 84 patients, and the donor site was covered by a full thickness skin graft in the other 17 patients. Results After operation, 98 patients had an incision healing by first intention and the flaps survived well; the other 3 patients had congestion and necrosis in the flap edges, and had a delayed healing after the dressing changes. All the donor sites had a healing by first intention. The followup of all the patients for 224 months averaged 6.5 months revealed that 9 patients, who had been given the paraumbilical skin flap, had a fat and clumsy finger; 14 patients, who had been given the groin skin flap, also had a fat and clumsy finger; 3 patients developed congestion and necrosis at their edges. The remaining patients had a satisfactory survival of the skin flaps and a normallyshaped finger. The flaps had a good appearance, with the twopoint discrimination of 510 mm, the good finger motion ability, and the satisfactory finger appearance.Conclusion The volar digital advancement flap,the island flap from the dorsum of the index finger, the lateral digital neurov ascular island flap, and the island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum are good skin flaps for repair of the finger deep burns. The groin skin flap and the paraumbilical skin flap are also good skin flaps for repair of the deep burns of the mutiple fingers but the postoperative finger may become a bit fat and clumsy.
Thumb and finger reconstruction by the method of pedal digit transplantation had been successfully performed in 541 casee from 1977 to 1996, which contained 404 cases of thumbs and 78 cases of fingers. The thumb reconstruction was mainly the simple transplantation of distal phalanx (42 cases) and the compound transplantation of hallucal nail-cutaneous flap with iliac bone segment (16 cases) for the defect of thumbs in degree 1 and 2. The combined transplantation of hallucal nail-cutaneous flap with the joint and tendons of the second toe (34 cases) and the transplantation of the distal part of the second toe (182 cases) for the defect of degree 3 and 4. The combined transplantation of the second pedal digit with its metatarsalphalangeal joint (189 caese) for the defect in degree 5 and 6. The finger reconstruction was performed by anastomosis of the arteries of the digit with those of the fingers for 29 cases with the defect in degree 2 and 3, 60 cases with the defect in degree 4 and 5, and 17 cases with the defect in degree 6. One-hundred and four cases of versels vasiation were found in this group (19 cases with the pedal dorsal artery, 13 cases with the greater saphenous vein and 72 cases with the first dorsal metatarsal artery). The main point of the operation and the treatment of the vessel variations were discussed.
Objective To investigate the method and effectiveness of repairing fingertip defects with reverse island flappedicled with terminal dorsal branch of digital artery with sense reconstruction. Methods Between December 2008 and March2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases),ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm × 1.0 cm to 2.2 cm ×1.8 cm, and the flap area ranged from 1.5 cm × 1.0 cm to 2.5 cm × 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed withstump of proper digital nerve. The donor sites were repaired with free skin grafts. Results Bl isters occurred in 6 cases (9 fingers) andpartial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers. Conclusion It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is rel iable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.
Patients receiving venous skin grafts having 3 different patterns of nutrient supply were introduced. It was considered that the venous skin graft had contain role in the repair of skin defects of fingers and dorsum of hands. The mechanism of the survival of the venous skin graft was discussed. It was assumed that, in the early stage, the skin nutrient was possibly in relation with the effusion or exudation from the wound surface, and in the later stage, depended upon the collateral circulation established with the surrounding tissues.
OBJECTIVE: To discuss the indication of replantation of destructive amputation of multiple fingers for improvement of the function of injured fingers. METHODS: From February 1996 to August 1999, 23 amputated fingers in 8 cases were shortened and replanted. The crushed digital bones were fixed by Kirschner wires, flexor tendons repaired by Kessler suture technique, and digital extensor tendons repaired by mattress suture. The arteries and veins were anastomosed in each finger at the ratio of 1 to 2 or 2 to 3. The defect of blood vessels was repaired by free graft of autologous veins in 5 fingers. All of the cases were followed up for 10 to 18 months, and clinical evaluation was performed. RESULTS: All replanted fingers survived in the 8 cases, with good sensation, two point discrimination of 6 to 12 mm, and satisfied function, such as pinching, grasping and hooking. The fingers were shortened for 2.6 cm in average, ranging from 2.2 cm to 4.0 cm. CONCLUSION: Multiple digits replantation by shortening fingers is beneficial to functional restoration of segmental destructive fingers.
Double adjacent-finger skin flap could be used to treat severe cicatricial contracture of fingers with resultant complete release of contracture and good coverage of raw surface. From the follow-up, it was noted that the appearance of the fingers following treatment looked nice, no recurrence of contracture in the late stage, and partial sensation of the fingers could be recovered as well. It had no ill-effect on the donor fingers, The method was simple and reliable,from 1987, a total of 4 cases had been done,and the functional recovery wassatisfactory.
OBJECTIVE In order to investigate the causes of necrosis of the retained flap after transplantation of the great nail flap, according to the principle of plastic surgery, the following operation was designed. METHODS A tongue-shaped great toe flap was made with its base on the tibial side of the great toe and the width of the base was 1 cm to 1.5 cm. The flap contained the supporting vessels and nerves and the periosteum was also preserved. RESULTS From June 1982 to November 1997, the flap was used to repair 267 case, 277 fingers defects. After operation, the retained flap on the tibial side developed necrosis in 13 sides, an incidence of 4.69%, and in 78 sides, there was necrosis on the grafted skin on the donor site, an incidence of 28.7%. Most of the wounds healed after changing dressing, while 37 wounds healed from another skin graft. Of these cases, 178 cases had been followed up for 5 months to 16 years. It was found that the retained tibial tongue-shaped flap showed hyperplasia which extended to the weightbearing area of metatarso-phalangeal of great toe. It showed that the taking off of great toe nail flap according to first dorsal metatarsal artery (FDMA) I, II or III type, the incidence of development of necrosis of retained flap on tibial side showed no significant difference (P gt; 0.05). CONCLUSION It was believed that the necrosis of the retained flap was not related to the FDMA classification but had relation with the design, operative technique and presence of infection.
The comprehensive rehabilitative treatment was used in 58 cases(194 finger)for functional impairment after eplantation. After the treatment the overall increase of flexion-extension range of motion was 30 to 130 degrees respectively. From the assessment of 10 items of daily activities, the patients could accomplish three-fourth of them. the average time taken for the treatment was 3 months with an excellent-good rate about 87.4%. Through the early comprehensive rehabilititive treatment patients could achieve better results.