Objective To investigate the clinical application of micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist to repair skin defect of finger. Methods Twenty-six cases (26 fingers) with skin defect of finger were repaired with micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist between December 2011 and February 2013. There were 20 males and 6 females with the average age of 31.5 years (range, 20-56 years). The causes of injury included cutting injury in 20 cases and crushing injury in 6 cases. The time from injury to admission was 1-5 hours with an average of 2 hours. Injured fingers included thumb in 6 cases, index finger in 6 cases, middle finger in 6 cases, ring finger in 4 cases, and little finger in 4 cases; the locations were the dorsal side of the finger in 6 cases, lateral side in 6 cases, and the volar of the finger tip in 14 cases; there were 4 cases on the proximal phalangeal skin, 8 cases on the middle phalangeal skin, and 14 cases on the distal phalangeal skin. The defect area ranged from 2.0 cm × 1.5 cm to 4.0 cm × 2.0 cm, and the flap area ranged from 2.5 cm × 2.0 cm to 4.5 cm × 2.5 cm. All the donor sites were directly sutured. Results The flaps of 25 cases survived well after operation, and wound healed by first intention； 1 case had partial necrosis and the wound had a scar healing by changing dressing. All cases were followed up 6-12 months (mean, 10 months). The color and appearance of the flaps were satisfactory with tender texture. The two-point discrimination of the flap was 5-8 mm (mean, 6.8 mm). The donor sites healed primarily without scar contracture and limitation of wrist flexion or extension. Conclusion The micro transverse flap pedicled with superficial palmar branch of radial artery from palmar wrist is a good option to repair skin defect of finger. It has the advantages of hidden donor site, the same operative field, great comparability of flap and finger skin, and it can be used as a vascularized tendon or nerve graft.
Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm × 2.3 cm to 4.2 cm × 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.
Objective To investigate the operative procedure and the clinical results of the island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery for repairing finger soft tissue defect. Methods Between January 2008 and March 2012, 28 cases of tissue defect of fingers (32 fingers) were repaired with the island flaps based on the vascular chain of the cutaneous branch of dorsal metacarpal artery. There were 20 males (23 fingers) and 8 females (9 fingers), with an average age of 29.5 years (range, 14-67 years). The injury causes included 14 cases of crush injury, 6 cases of pressing injury, 5 cases of cutting injury, and 3 cases of avulsion injury. The locations included 10 index fingers, 13 long fingers, 6 ring fingers, and 3 little fingers. There were 9 defects of proximal segment, 12 defects of middle segment, and 11 defects of distal segment. The area of defect ranged from 1.0 cm × 0.8 cm to 5.2 cm × 3.5 cm. The disease duration was 1 hour to 15 days. The area of flaps ranged from 1.2 cm × 1.0 cm to 5.5 cm × 3.8 cm. The donors were closed by suture or were repaired with skin graft. Results Tense blister occurred in 3 cases, which was cured after dressing change; the other flaps survived. Wound obtained primary healing. Twenty-five patients (27 fingers) were followed up 6-25 months (mean, 16.8 months). The flaps had soft texture and satisfactory appearance. Two point discrimination was 6-9 mm (mean, 7.7 mm) at 6 months after operation. The total active movement of fingers was 105-230° (mean, 204.6°). The results were excellent in 17 fingers, good in 8 fingers, and fair in 2 fingers with an excellent and good rate of 92.6%. Conclusion The island flap based on the vascular chain of the cutaneous branch of dorsal metacarpal artery has the advantages of the deverting point from the dorsal point to the palm, the extended vessel pedicle, and expanded operation indications, so it is not necessary to cut the dorsal metacarpal artery. It can be used to repair finger tissue defect.
Objective To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled. Methods Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years(mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13cases, middle finger in 11 cases, ring finger in 9 cases, and l ittle finger in 7 cases. The defect area ranged from 3.0 cm × 2.0 cm to 5.5 cm × 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arteril ization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm × 1.5 cm to 2.6 cm × 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm × 2.0 cm to 3.5 cm × 2.5 cm. The donor sites were covered with free flaps. Results Flap bl ister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and goodrate was 96.7%. Conclusion The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easyto- operate with less injury.
Objective To investigate the cl inical results of cross-finger flap combined with laterodigital pedicled skin flap for repair of severe flexion contracture of the proximal interphalangeal joint. Methods Between October 2008 and February 2011, 11 patients (11 fingers) with severe flexion contracture of the proximal interphalangeal joint were treated with cross-finger flap combined with laterodigital pedicled skin flap. There were 7 males and 4 females, aged 20-63 years (mean, 32.6years). The causes of injury were crush or electric-saw injury in 7 cases, burn or explosive injury in 3 cases, and electrical injury in 1 case. The locations were the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 2 cases, and the l ittle finger in 3 cases. The mean disease duration was 12.4 months (range, 6-24 months). All cases were rated as type III according to Stern classification standard. The volar tissue defect ranged from 3.0 cm × 1.5 cm to 5.0 cm × 2.5 cm, with exposed tendons, nerves, vessels, or bone after scar relaxation. The defects were repaired with cross-finger flaps (2.2 cm × 1.8 cm to 3.8 cm × 2.5 cm) combined with laterodigital pedicled skin flaps (1.5 cm × 1.2 cm to 2.5 cm × 2.0 cm). Double laterodigital pedicled skin flaps were used in 3 cases. The flap donor site was sutured directly or repaired with the skin graft. Results All flaps survived completely and wound healed by first intention. The donor skin graft survived. All the patients were followed up 6-18 months (mean, 11.3 months). The finger appearance was satisfactory. The flaps had soft texture and good color in all cases. No obvious pigmentation or contraction was observed. The contracted fingers could extend completely with good active flexion and extension motion. At last follow-up, the extension of the proximal interphalangeal joint was 10-15°. Based on proximal interphalangeal joint motion standard of Chinese Medical Association for hand surgery, the results were excellent in 6 cases, good in 4 cases, and fair in 1 case; the excellent and good rate was 90.9%. Conclusion It is an easy and simple therapy to cover wound area of severe flexioncontracture of the proximal interphalangeal joint after scar relaxation using cross-finger flap combined with laterodigital pedicled skin flap, which can repair large defect and achieve good results in finger appearance and function.
Objective To analyze the effectiveness and advantages of the microsurgical repair of flexor tendon rupture with non-knot Kessler suture method in anastomotic stoma by comparing with the method of traditional Kessler suture. Methods Between February 2005 and February 2010, 122 patients (163 fingers with 243 flexor digital tendons) with flexor tendon rupture, were treated with microsurgical repair by non-knot Kessler suture method (treatment group); flexor tendon was sutured, and sodium hyaluronate was used to repair tendon membrane, tendon sheaths, and the tissue surroundingtendons. The cl inical data were analysed, and were compared with ones from 96 patients (130 fingers with 186 flexor digital tendons) with flexor tendon rupture treated with traditional Kessler suture between February 2001 and February 2005 (control group). There was no significant difference in gender, age, cause of injury, injury site, duration, and other general information between 2 groups (P gt; 0.05). Kleinert elastic traction therapy (dynamic-protection) was performed at 3 weeks after surgery, and the finger function exercise was done after 24 hours. Results Infection of incision occurred in 2 cases of the treatment group and in 5 cases of the control group, and were cured after 2 weeks of dressing change; the other incisions healed by first intention. The patients were followed up 6 to 14 months (mean, 9 months). In the treatment group, the total active movement (TAM) was (192.0 ± 13.1)°; the results were excellent in 54 cases, good in 58 cases, moderate in 8 cases, and poor in 2 cases with an excellent and good rate of 92%. In the control group, TAM was (170.0 ± 15.2)°; the results were excellent in 23 cases, good in 30 cases, moderate in 22 cases, and poor in 21 cases with an excellent and good rate of 55%. Significant difference in TAM was found between 2 groups (P lt; 0.01). Conclusion The microsurgical repair of flexor tendon with non-knot Kessler suture method in anastomotic stoma with repair of tendon membrane, tendon sheaths, and the tissue surrounding tendons is more effective than the traditional Kessler suture, but long-term effectiveness still needs further observation.