Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf
ObjectiveTo summarize the clinical experience of the retrograde replantation for amputated toe. MethodsBetween January 2010 and August 2015, 11 cases of amputated toes (15 toes) were treated by the retrograde replantation. All patients were male, with a mean age of 31 years (range, 18-45 years). The causes included cutting injury in 6 cases (9 toes) and crush injury in 5 cases (6 toes). One case had amputated great toe and distal segment of the second toe combined with the third toe nail bed contusion; 1 case had amputated proximal great toe and middle segment of the second and third toes; 1 case had amputated proximal segment of great toe and middle segment of the second toe; 7 cases had amputated distal segment of the great toe; and 1 case had amputated middle segment of the fifth toe. The time from injury to hospital was 1-3 hours (mean, 2 hours). ResultsThirteen toes survived completely after operation. Toe necrosis occurred in 1 toe; partial dorsal skins necrosis and nail bed necrosis occurred in 1 toe, and was cure after repaired with dorsalis pedis island flap. The rate of success for replantation of amputated toes was 93.33% (14/15). X-ray examination showed fracture healing of all survival toes at 8-12 weeks after operation (mean, 10 weeks); internal fixation was removed. Eleven cases were followed up 3-12 months (mean, 7.5 months). The survival toes had good appearance and toenail. The two point discrimination was 9-12 mm (mean, 10 mm) at last follow-up. The patients could walk and run normally. ConclusionIt is an ideal surgical method to use retrograde replantation to treat amputated toe, with the advantages of simple operation and high survival rate.
Objective To investigate the feasibility of temporary ectopic implantation of amputated fingers and dorsalis pedis flaps for thumb reconstruction and skin defect repair of the hand. Methods Between February 2006 and February 2012, 9 patients with thumb amputation having no replanted condition were treated. There were 7 males and 2 females with an average age of 35 years (range, 20-45 years). The injury causes included explosive injury in 1 case, puncher injury in 1 case, stiring machine injury in 1 case, gear injury in 3 cases, and heavy pound injury in 3 cases. At 2-5 hours after injury, one-stage temporary ectopic implantation of amputated finger to foot was performed. After debridement, thumb defect was rated as degree III in 1 case, as degree IV in 3 cases, and as degree V in 5 cases. When amputated fingers survived completely after 1-4 months, the amputated finger was replanted to its anatomic position, skin defect was repaired with dorsalis pedis flap. The area of skin defect ranged from 5 cm × 4 cm to 7 cm × 6 cm. The area of flaps ranged from 6 cm × 5 cm to 8 cm × 7 cm. The donor site was repaired by the skin grafting. Results Arterial crisis occurred in 1 case after 1 day of one-stage operation, and was cured after vascular exploration, and the amputated fingers survived in the others. The reconstructed thumbs and flaps survived after two-stage operation, and the skin graft at donor site survived. The patients were followed up 1-4 years (mean, 2.8 years). The reconstructed thumbs had good appearance and satisfactory opposition and finger-to-finger functions. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the scores of survival fingers were 73-91 (mean, 84); the results were excellent in 7 cases and good in 2 cases with an excellent and good rate of 100%. Conclusion Temporary ectopic implantation of amputated finger to foot combined with dorsalis pedis flap can be used to reconstruct thumb and repair skin defect of the hand.