OBJECTIVE: To evaluate clinical result of reconstructed thumb and finger with a free hallux nail flap(HNF) and frozen-phalanx-joint-tendon-sheath composite tissue allograft in 270 cases. METHODS: The patients were followed up with reexamination in the ambulant clinic, communication, X-ray photography, lab-examination, isotope 99mTc MDP and reoperation. The data were analyzed by statistics or proved by clinical observation, which were followed up for five years in average (ranging from five months to sixteen years). RESULTS: Enveloping the allogeneic finger composite tissue with self-HNF and pieces of phalanx of great toe, it could reconstruct a thumb or finger with good contour and nutrition. The excellent rate of opposition function of the reconstructed thumbs was 71.91%. The sense of the fingers recovered after 3 months to 8 months of operation. Two-point discrimination was 3 mm to 15 mm. The junction between implanted allo-phalanges and auto-phalanges could be hastened by implanted with vascularized autogenous phalanx pieces in the HNF. The isotope 99mTc MDP was used to take X-ray photography in 24 cases for four months to 9 years and seven months, which showed that the blood vessels grew into the allo-phalanges. However, the Charcot’s arthropathy of allogeneic joints and bony absorption still could be seen in some cases. That might be concerned with chronic abrasion of joint or chronic rejection of host to graft. CONCLUSION: The operation is fit for repairing the defect of thumb or finger in any degree. The implanted vascularized self-phalanx pieces can promote bone union, but it can not prevent the allogeneic joints from arthropathy or bone absorption
Objective To investigate the effectiveness of using lateral homodigital flaps pedicled with cutaneous branches of digital artery for repairing nail bed defects. Methods Between December 2008 and July 2010, 5 patients with nail bed defects were repaired with lateral homodigital flaps pedicled with cutaneous branches of digital artery. Nail bed defects were caused by crush injury of machine. There were 3 males and 2 females, aged from 22 to 35 years (mean, 28 years). Injured fingers included 3 thumbs, 1 index finger, and 1 middle finger. The size of the defects ranged from 1.1 cm × 1.0 cm to 1.8 cm × 1.2 cm and the size of the flaps ranged from 2.7 cm × 1.3 cm to 3.1 cm × 1.7 cm. The donor sites were covered by skin graft. The time between injury and admission ranged from 1 hour and 12 minutes to 3 hours and 24 minutes (mean, 2.1 hours). Results All flaps and skin grafts survived, and the incision healed by first intention. The follow-up time ranged from 6 to 9 months (mean, 7.5 months). The fingers had good appearance. Four cases gained full postoperative sensory recovery and the two-point discrimination was 4-5 mm at 3 months after operation, but it did not recover in 1 case at last follow-up. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medicine Association, the results were excellent in 4 cases and good in 1 case. Conclusion The lateral homodigital flaps pedicled with cutaneous branches of digital artery can repair nail bed defects without sacrifice of digital artery, and can gain a full sensory recovery. It is a feasible solution for treatment of nail bed defects especially for those unwilling to cause any damage to their toes.
To investigate the operative method of repairing soft tissue defect of finger with modified reverse dorsal digital fascia flap and its cl inical effect of preventing and treating venous crisis. Methods From February 2005 to March 2007, 19 cases (22 fingers) with soft tissue defect of finger were treated, including 14 males (17 fingers) and 5 females (5 fingers) aged 2-62 years old (median 26 years old). There were 8 cases of cutting injury, 6 cases of crush injury, 4 cases of avulsion injury, and 1 case of hot crush injury, involving 3 thumbs, 7 index fingers, 6 middle fingers, 4 ring fingers and 2 l ittle fingers. The size of soft tissue defect was 1.5 cm × 0.8 cm-5.5 cm × 1.5 cm, and the time from injury to operation was 2-11 hours(average 7 hours). The axis of flaps was the l ine of transverse striation of fingers via dominant artery. The flaps were deflected dorsally, as “b” or “d”, to cover the wounds. Reverse dorsal digital fascia flaps 1.8 cm × 1.0 cm-6.0 cm × 2.0 cm in size were adopted to repair the defects. The donor site underwent skin grafting fixation. Results All flaps survived, without venous crisis and obvious swollen. The grafted skin in the donor site all survived. All patients were followed for 6-18 months (average 11 months). Postoperatively, color and texture of the grafted flaps were similar to that of normal skin, and the pulp of the fingers was normal. The two-point discrimination was 8-11 mm, and the activities of interphalangeal joint of all injured fingers were normal. Conclusion The modified reverse dorsal digital fascia flap is ideal for repairing soft tissues defects of the fingers, and can decrease the occurrence of venous crisis.
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.
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.