Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Wei ,  LIANG Gaofeng , ZHANG Manying , JIA Zhongyu , JIA Zonghai , DONG Junwen , DUAN Chaopeng , ZHI Feng , TENG Yunsheng , GUO Yongming

The First Department of Hand Surgery, 521 Hospital of Norinco Group, Xi’an Shaanxi, 710065, P. R. China;

Corresponding author：

LIANG Gaofeng, Email: lgflgf4488@163.com

Keywords：

High-pressure injection injury; cross-finger flap; perforator flap; soft tissue defect

DOI：

10.7507/1002-1892.202305022

Video：

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Objective To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. Methods Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. Results All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. Conclusion The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.

Citation： ZHANG Wei, LIANG Gaofeng, ZHANG Manying, JIA Zhongyu, JIA Zonghai, DONG Junwen, DUAN Chaopeng, ZHI Feng, TENG Yunsheng, GUO Yongming. Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1138-1141. doi: 10.7507/1002-1892.202305022 Copy

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2.	王涛, 顾玉东, 姜宗圆, 等. 手部高压注射伤的治疗. 中华手外科杂志, 2003, 19(4): 226-227.
3.	Rees CE. Penetration of tissue by fuel oil under high pressure from a diesel engine. JAMA, 1937, 19(11): 866-867.
4.	Eells AC, McRae M, Buntic RF, et al. High-pressure injection injury: a case report and systematic review. Case Reports Plast Surg Hand Surg, 2019, 6(1): 153-158.
5.	Feldman G, Rozen N, Eliyahu AC, et al. High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement. Hand Surg Rehabil, 2019, 38(5): 312-316.
6.	穆钛飞, 王成, 陈世玖. 手部高压注射伤的损伤机制与治疗进展. 医学综述, 2021, 27(8): 1585-1590.
7.	Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma, 2006, 20(7): 503-511.
8.	谢松林, 唐举玉, 陶克奇, 等. 指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖. 中国临床解剖学杂志, 2010, 28(1): 97-100.
9.	张文龙, 赵刚, 马爱国, 等. 指掌侧固有动脉背侧支皮瓣的显微解剖与临床应用. 中华显微外科志, 2015, 38(2): 107-110.
10.	王志浩, 丛海波. 邻指皮瓣临床应用进展. 实用手外科杂志, 2013, 27(4): 392-393, 396.
11.	贾宗海, 梁高峰, 耿朝萌, 等. 携带隐神经终末支的游离足内侧皮瓣在手部高压注射伤中的应用. 中国修复重建外科杂志, 2020, 34(2): 270-271.
12.	罗小庆, 黄忠果. 邻指指固有动脉背侧支皮支链皮瓣修复手指软组织缺损. 中华显微外科杂志, 2016, 39(4): 398-399.
13.	梁高峰, 张伟, 段超鹏, 等. 游离足底内侧Flow-through皮瓣修复手指软组织缺损12例. 中华显微外科杂志, 2019, 42(4): 411-413.

1. 潘生德, 顾玉东, 侍德. 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.
2. 王涛, 顾玉东, 姜宗圆, 等. 手部高压注射伤的治疗. 中华手外科杂志, 2003, 19(4): 226-227.
3. Rees CE. Penetration of tissue by fuel oil under high pressure from a diesel engine. JAMA, 1937, 19(11): 866-867.
4. Eells AC, McRae M, Buntic RF, et al. High-pressure injection injury: a case report and systematic review. Case Reports Plast Surg Hand Surg, 2019, 6(1): 153-158.
5. Feldman G, Rozen N, Eliyahu AC, et al. High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement. Hand Surg Rehabil, 2019, 38(5): 312-316.
6. 穆钛飞, 王成, 陈世玖. 手部高压注射伤的损伤机制与治疗进展. 医学综述, 2021, 27(8): 1585-1590.
7. Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma, 2006, 20(7): 503-511.
8. 谢松林, 唐举玉, 陶克奇, 等. 指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖. 中国临床解剖学杂志, 2010, 28(1): 97-100.
9. 张文龙, 赵刚, 马爱国, 等. 指掌侧固有动脉背侧支皮瓣的显微解剖与临床应用. 中华显微外科志, 2015, 38(2): 107-110.
10. 王志浩, 丛海波. 邻指皮瓣临床应用进展. 实用手外科杂志, 2013, 27(4): 392-393, 396.
11. 贾宗海, 梁高峰, 耿朝萌, 等. 携带隐神经终末支的游离足内侧皮瓣在手部高压注射伤中的应用. 中国修复重建外科杂志, 2020, 34(2): 270-271.
12. 罗小庆, 黄忠果. 邻指指固有动脉背侧支皮支链皮瓣修复手指软组织缺损. 中华显微外科杂志, 2016, 39(4): 398-399.
13. 梁高峰, 张伟, 段超鹏, 等. 游离足底内侧Flow-through皮瓣修复手指软组织缺损12例. 中华显微外科杂志, 2019, 42(4): 411-413.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger

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