The digital defects which severely interfered with the hand functions must be reconstructed. The primary repair by vascularized skin flap with the dorsal branch of proper palmar digital nerve could be done. The vascularized flap was rich in blood circulation, perfect sensibility and a good contour, as well as preserving donor digital sensation. However, it was simple, safe, and with higher success. From 1989 to 1991, 10 cases of digital defects were treated, all of the patients gained very good results. The indication and technique of thismethod wasdiscussed in detail.
Objective To investigate the therapeutic effect of V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery for skin defect at the same dorsal finger. Methods Between January 2008 and February 2010, 15 cases of skin defect at the same dorsal finger were treated. There were 9 males and 6 females, aged 15-72 years (mean, 43 years). Defect was caused by saw machine in 6 cases, machines crush in 7 cases, and cutting nodule in 2 cases. The locationswere distal dorsal finger in 2 cases, middle dorsal finger in 6 cases, and proximal dorsal finger in 7 cases. All cases compl icated by exposure of tendon and bone. The size of defect ranged from 0.8 cm × 0.5 cm to 1.4 cm × 1.0 cm. The interval between injury and operation was 3-8 hours. All fingers were treated by V-Y advancement flap from the dorsal cutaneous branch of digital artery, which size was 1.2 cm × 0.8 cm-2.5 cm × 1.0 cm, and the donor site was directly sutured. Fracture reductionand Kirschner wire for internal fixation were performed in the patients with fracture; extensor tendon was repaired with 4-0 thread in the patients with tendon injury. Results All flaps survived completely. The incisions of donor and recipient sites healed by first intention. Ten cases were followed up 6 months to 2 years after operation. The flaps had good texture, color, and appearance; 2-point discrimination of the V-Y flap was 10-12 mm. X-ray examination showed that all finger fractures healedsuccessfully in 5 cases, with an average bone union time of 6 weeks (range, 5-8 weeks). According to the criteria for function assessment by total active motion, the results were excellent in 8 cases, good in 1, and fair in 1 with an excellent and good rate of 90%. Conclusion It is an ideal method to treat skin defect at the same dorsal finger with V-Y advancement flap pedicled with dorsal cutaneous branch of digital artery.
ObjectiveTo explore the effectiveness of anterograde fascial flap of digital artery in reconstruction of Wassel Ⅳ-D thumb duplication.MethodsTwelve cases of Wassel Ⅳ-D thumb duplication were treated with anterograde fascial flap of digital artery between June 2014 and March 2017. There were 7 boys and 5 girls with an age of 9-32 months (mean, 13.3 months). Eight cases were on the left side and 4 cases on the right side. The main bunion bed width was 70%-85% of the healthy side (mean, 75.3%). The degree of fullness was 50%-75% of the healthy side (mean, 62.4%). The anterograde fascial flap with one proper digital artery was used to fill the nail fold on the radial side of the finger and increase the circumference of the finger. At last follow-up, the ratio of circumference of deformed finger to contralateral finger was measured at the base of nail. The appearance and function of all reconstructed thumbs were evaluated with Japanese Society for Surgery of the Hand (JSSH) scoring.ResultsAll the operations were successfully completed without early complications such as infection and skin necrosis. All children were followed up 7-27 months (mean, 14.3 months). At last follow-up, there was no recurrence of deformity in the digital body and no obvious change of scar contracture in the surgical wound. Pulp and nail fold symmetry improved in all cases. The ratio of circumference of deformed finger to contralateral finger was 93%-96% (mean, 94.7%). The JSSH score was 15-20 (mean, 17.9); the results were excellent in 8 cases, good in 2 cases, and fair in 2 cases.ConclusionThe anterograde fascial flap of digital artery is a safe and effective approach to restore symmetry for esthetic improvement in treatment of Wassel Ⅳ-D thumb duplication.
Objective To investigate the effectiveness of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Methods Between February 2013 and July 2016, 11 cases (11 fingers) of mid-phalanx degloving injury with distal segment finger defect were treated. There were 9 males and 2 females with an average age of 33.6 years (range, 18-59 years). The injury caused by twisting in 8 cases and crushing in 3 cases. The injury located at index finger in 3 cases, middle finger in 6 cases, and ring finger in 2 cases. The skin avulsion was from proximal interphalangeal joint in 1 case, proximal 1/4 of mid-phalanx in 6 cases, and 1/2 of mid-phalanx in 4 cases. The area of wounds ranged from 4.0 cm×1.7 cm to 6.2 cm×2.6 cm. The interval between injury and operation was 2.5-6.0 hours (mean, 4.5 hours). All defects were repaired with the ipsilateral digital proper artery dorsal branch flaps. The size of flaps ranged from 4.4 cm×1.9 cm to 7.0 cm×2.9 cm. Nerve anastomose was carried between digital proper nerve dorsal branch in the flap and digital proper nerve stump in the wound. The donor sites were repaired by skin grafting. Results Tension blisters of the flap and partial necrosis occurred in 1 case, and healed after dressing change. The other flaps and skin grafting survived, and wounds healed by first intention. All patients were followed up 6-18 months (mean, 16 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination of flaps ranged from 7 to 10 mm (mean, 8.5 mm). At last follow-up, according to the functional assessment criteria of upper limbs by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 10 cases and good in 1 case, with the excellent and good rate of 100%. Conclusion The ipsilateral digital proper artery dorsal branch flap is a good method to repair mid-phalanx degloving injury with distal segment finger defect for the advantages of simple operation, less damage in donor site, high survival rate of the flap, and good feeling recovery of the finger.