REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGHuanyou ¹ ,  WANGBin ¹ , LUAidong ² , LIRuiguo ¹ , CHENChao ¹ , MATiepeng ¹

1. Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;
2. Department of Surgery, the Kailuan Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

WANGBin, Email: wbladyp3@sohu.com

Keywords：

Side island flap; Thumb pulp defect; Sensory reconstruction

DOI：

10.7507/1002-1892.20140190

Video：

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Objective To explore the effectiveness of the side island flap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects. Methods Between May 2008 and July 2012,36 cases of thumb pulp defects were treated with the side island flap coinciding dorsal branch of the digital nerve.There were 26 males and 10 females,aged 21-51 years (mean,32.4 years).The injury causes included electric saw injury in 14 cases,punch press injury in 8 cases,machine twist injury in 5 cases,door crushing injury in 5 cases,and glass cutting injury in 4 cases.The left hand was involved in 12 cases and the right hand in 24 cases.Combined injuries included tendon and bone exposure in all cases,fracture of the distal phalanx in 3 cases,and nail bed lacerations in 2 cases.The defect size ranged from 1.4 cm×1.2 cm to 2.5 cm×2.1 cm;and the flap size ranged from 1.8 cm×1.4 cm to 3.0 cm×2.5 cm. Results Two flaps with distal skin flap tension blisters and skin scabbing,which were cured after dressing changes;the wound healed by first intension in the other 34 cases.The skin grafts at donor site survived,and primary healing of incision was obtained.The patients were followed up 3-15 months (mean,8 months).The appearance and function restored well.Two-point discrimination of the flap was 5.2 mm on average (range,4-8 mm) at last follow-up.The finger joint had no stiff.According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,the sensation was S₄ in 33 and S_3⁺ in 3 cases.No ectopic feeling was observed.The extension and flexion activity of fingers at donor site was normal,the sensation reached S₄ with no atrophy of the finger. Conclusion With constant anatomy,reliable blood supply,and safe operation,the anastomoses of the finger side island flap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also effectively overcome the ectopic feeling with traditional methods and protect feel function of the fingers at donor site.

Citation： YANGHuanyou, WANGBin, LUAidong, LIRuiguo, CHENChao, MATiepeng. REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 862-864. doi: 10.7507/1002-1892.20140190 Copy

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2.	张智,马远征,赵东升,等.带神经邻指近节指背逆行岛状皮瓣修复指腹缺损.中国修复重建外科杂志,2009,23(11):1397-1398.
3.	孙广峰,王达利,魏在荣,等.拇指背侧皮神经营养血管筋膜蒂逆行皮瓣修复拇指指腹缺损.中国修复重建外科杂志,2009,23(5):634-635.
4.	张志海,寿奎水,芮永军,等.吻合神经的拇指背侧皮神经营养血管皮瓣修复拇指腹缺损.中华手外科杂志,2006,22(5):270-271.
5.	郑良军,郭翱,李俊,等.指动脉背侧支皮瓣游离移植修复指端缺损的疗效评价.中华手外科杂志,2013,29(2):73-74.
6.	Zhang X,He Y,Shao X,et al.Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect.J Hand Surg (Am),2009,34(8):1467-1473.
7.	Shao X,Chen C,Zhang X,et al.Coverage of fingertip defect using a dorsal island pedicele flap including both dorsal digital nerves.J Hand Surg (Am),2009,34(8):1474-1481.
8.	徐卫东,李方奇,章祥州,等.拇指背侧动脉逆行皮瓣修复电击伤后拇指软组织缺损.中华手外科杂志,2013,29(3):159-160.
9.	蔡若赋,周杰,党书汉,等.超微型皮瓣在修复手指指端及指腹皮肤缺损中的应用.中华手外科杂志,2013,29(5):276.
10.	费剑荣,杨科跃,孙涛,等.游离大鱼际肌穿支皮瓣修复指腹软组织缺损.中华手外科杂志,2013,29(3):157-158.
11.	Tellioglu AT,Sensoz O.The dorsal branch of the digital nerve:an anatomic study and clinical applications.Ann Plast Surg,1998,40(2):145-148.
12.	邢丹谋,周必光,彭正人,等.指固有神经背侧支的应用解剖学研究.中华手外科杂志,2001,17(1):52-54.
13.	赵民,邵新中,田德虎,等.指动脉背侧支逆行筋膜蒂岛状皮瓣修复手指皮肤缺损.中国修复重建外科杂志,2005,19(6):453-454.
14.	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.
15.	Chen C,Zhang X,Shao X,et al.Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap.J Hand Surg (Am),2010,35(10):1663-1670.
16.	Littler JW.Neurovascular pedicle method of digital transposition for reconstruction of the thumb.Plast Reconstr Surg (1946),1953,12(5):303-319.
17.	谭旭昌,刘景臣.指固有动脉岛状皮瓣逆行修复指末节软组织缺损.中华显微外科杂志,2004,27(4):298-299.
18.	郑文忠,陈昆,苏鸿君,等.手指近端微型岛状皮瓣修复指腹缺损.中华显微外科杂志,2009,32(2):151.
19.	高顺红,陈超,孙来卿,等.手指皮肤缺损的显微外科修复.中华显微外科杂志,2011,34(3):227-229.
20.	侯春林.带血管蒂组织瓣移位手术图解.2版.上海:上海科学技术出版社,1997:114.
21.	李启超,张双喜,陈振喜,等.指固有神经背侧支移位重建指腹感觉功能.中华手外科杂志,2011,27(1):33-34.

1. 李庆泰,田光磊.手外科诊断学.2版.北京:人民卫生出版社,2009:257.
2. 张智,马远征,赵东升,等.带神经邻指近节指背逆行岛状皮瓣修复指腹缺损.中国修复重建外科杂志,2009,23(11):1397-1398.
3. 孙广峰,王达利,魏在荣,等.拇指背侧皮神经营养血管筋膜蒂逆行皮瓣修复拇指指腹缺损.中国修复重建外科杂志,2009,23(5):634-635.
4. 张志海,寿奎水,芮永军,等.吻合神经的拇指背侧皮神经营养血管皮瓣修复拇指腹缺损.中华手外科杂志,2006,22(5):270-271.
5. 郑良军,郭翱,李俊,等.指动脉背侧支皮瓣游离移植修复指端缺损的疗效评价.中华手外科杂志,2013,29(2):73-74.
6. Zhang X,He Y,Shao X,et al.Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect.J Hand Surg (Am),2009,34(8):1467-1473.
7. Shao X,Chen C,Zhang X,et al.Coverage of fingertip defect using a dorsal island pedicele flap including both dorsal digital nerves.J Hand Surg (Am),2009,34(8):1474-1481.
8. 徐卫东,李方奇,章祥州,等.拇指背侧动脉逆行皮瓣修复电击伤后拇指软组织缺损.中华手外科杂志,2013,29(3):159-160.
9. 蔡若赋,周杰,党书汉,等.超微型皮瓣在修复手指指端及指腹皮肤缺损中的应用.中华手外科杂志,2013,29(5):276.
10. 费剑荣,杨科跃,孙涛,等.游离大鱼际肌穿支皮瓣修复指腹软组织缺损.中华手外科杂志,2013,29(3):157-158.
11. Tellioglu AT,Sensoz O.The dorsal branch of the digital nerve:an anatomic study and clinical applications.Ann Plast Surg,1998,40(2):145-148.
12. 邢丹谋,周必光,彭正人,等.指固有神经背侧支的应用解剖学研究.中华手外科杂志,2001,17(1):52-54.
13. 赵民,邵新中,田德虎,等.指动脉背侧支逆行筋膜蒂岛状皮瓣修复手指皮肤缺损.中国修复重建外科杂志,2005,19(6):453-454.
14. 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.
15. Chen C,Zhang X,Shao X,et al.Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap.J Hand Surg (Am),2010,35(10):1663-1670.
16. Littler JW.Neurovascular pedicle method of digital transposition for reconstruction of the thumb.Plast Reconstr Surg (1946),1953,12(5):303-319.
17. 谭旭昌,刘景臣.指固有动脉岛状皮瓣逆行修复指末节软组织缺损.中华显微外科杂志,2004,27(4):298-299.
18. 郑文忠,陈昆,苏鸿君,等.手指近端微型岛状皮瓣修复指腹缺损.中华显微外科杂志,2009,32(2):151.
19. 高顺红,陈超,孙来卿,等.手指皮肤缺损的显微外科修复.中华显微外科杂志,2011,34(3):227-229.
20. 侯春林.带血管蒂组织瓣移位手术图解.2版.上海:上海科学技术出版社,1997:114.
21. 李启超,张双喜,陈振喜,等.指固有神经背侧支移位重建指腹感觉功能.中华手外科杂志,2011,27(1):33-34.

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