It is difficult to repair the pulp defect of finger with good function. Here reported two cases of pulp defect of the thumb which were repaired with free palmris brevis musculo-cutaneous flap. The flap was designed as the following: taken the line crossing the pisiform and metacarpo-phalangeal joint of the little finger as the longitudinal axis of the flap. The proximal end of the flap was at the level of pisiform and the distal end was the distal transverse palmar crease. The radial border was the radial side of the palmris brevis and ulnar border was the ulnar edge of the palm. The flap should not be larger than 6.5 cm x 2.5 cm. The flap was dissected with proper ulnar vessels and the accompanying arterial branch and superficial branch of the ulnar nerve. The flap was transferred to repair the pulp defect of the thumb. The vessels were anastomosed with the radial artery and cephalic vein at the snuffbox. The nerves were sutured to the digital nerve. Three months after operation, the defect was healed and the sensation of pulp was recovered. The donor area was painless and without sensation disturbance. The motion of the little finger was normal. The function of the thumb was restored. It was concluded that the palmaris brevis musculocutaneous flap is one of the best donor region to repair pulp defect of thumb.
Objective To investigate the method and cl inical outcomes of repairing the skin and tissue defect of the finger pulp with transverse digital palmar island flap. Methods From August 2007 to September 2008, 9 patients with skin and tissue defects of the finger pulp were treated, including 6 males and 3 females aged 18-48 years old. The defect was caused bycrush injury by machine in 6 cases, pressure injury by heavy objects in 2 cases, and abrasion injury by grinding wheel in 1 case. The defect was located in the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 3 cases, the proximal phalanx in 1 case, the middle phalanx in 7 cases, and the distal phalanx in 1 case. The defect size ranged from 1.3 cm × 1.0 cm to 2.5 cm × 1.5 cm. The defect was compl icated with unilateral blood vessel and nerve defect in 8 cases, bone fracture in 2 cases, and tendon exposure in 5 cases. The time between injury and hospital admission was 20 minutes-14 hours. Transverse digital palmar island flaps (2.0 cm × 1.2 cm-4.0 cm × 1.7 cm) were used to repair the soft tissue defect during operation. The donor site was repaired with full-thickness skin graft. Results All the flaps and skin graft at the donor site survived uneventfully. All the wounds healed by first intention. Nine patients were followed up for 6-17 months. The appearance of the flaps was similar to that of the uninjured side, there was no occurrence of obvious pigmentation and scar contracture, and the two-point discrimination value was 8-11 mm. According to the function evaluation standard for the replantation of severed finger by Chinese Medical Association Hand Surgery Academy, 8 cases were graded as excellent, 1 as good. Conclusion Repairing the skin and tissue defects in the finger pulp of middle and distal phalanx with transverse digital palmar island flap can simpl ify the operation procedure, reduce the suffering of the patient, and provide satisfying therapeutic effect.
OBJECTIVE: To summarize the application of cross-arm skin flaps with lateral antebranchial cutaneous nerve in repair of soft tissue defect. METHODS: From March 1996 to March 2001, 37 cases of soft tissue defect at fingertips were repaired by cross-arm skin flaps with lateral antebranchial cutaneous nerve, 1.5 cm x 1.5 cm to 3.5 cm x 4.0 cm in size. All of the cases were followed up for 3-48 months with routine evaluation of the wound and the function of hands. RESULTS: All of the flaps survived and the wound achieved primary healing. The sensation and shape of hands recovered well. CONCLUSION: It’s a good choice to repair soft tissue defect at fingertips by cross-arm skin flaps with lateral antebranchial cutaneous nerve.
Objective To investigate the effectiveness of the island flap pedicled with the dorsal cutaneous branches of thumb radial digital artery from the same finger for repairing pulp defect. Methods Between June 2009 and March 2010, 10 patients (10 fingers) with pulp defect of thumb were treated. There were 6 males and 4 females, aged 13-68 years with an average of 38 years. Defect was caused by machine crush in 4 cases, by saw machine in 3 cases, by chronic infection in 2 cases, and by burn in 1 case. The disease duration was 3 hours to 4 months. In 4 cases of distal pulp defect (1.0 cm × 0.8 cm to 2.0 cm × 1.4 cm) with exposure of bone or tendon, defect was repaired with island flap pedicled with the interphalangeal joint cutaneous branches of thumb radial digital artery (1.0 cm × 0.8 cm to 2.2 cm× 1.5 cm). In 6 cases of proximal pulp defect (1.0 cm × 0.8 cm to 2.5 cm × 2.0 cm) with exposure of bone or tendon, defect was repaired with island flap pedicled with the metacarpophalangeal joint cutaneous branches of thumb radial digital artery (1.0 cm × 0.8 cm to 2.6 cm × 2.2cm). The donor sites were repaired with skin grafts. Results All flaps and skin grafts survived, and wounds healed by first intention. Ten cases were followed up 6-12months (mean, 8 months). The colour, texture, and contour of the flaps were good. The two-point discrimination was 7-10mm on the island flap at last follow-up. According to total active motion (TAM) standard, the thumb function was assessed as excellent in 8 cases, good in 1 case, and fair in 1 case, and the excellent and good rate was 90%. Conclusion The main digital artery and nerve of thumb will not be sacrified when the island flap pedicled with the dorsal cutaneous branches of thumb radial digital artery is used. The operative procedure is simple, so it is a good method for repairing pulp defect of thumb.