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.
Since 1992, the retrograde island skin flap with its pedicle containing the arteria pollicis dorsalis was used to repair 6 cases of the fingertip defects and the results were successful. The skin measured from 1.5cm x 2cm to 4cm x 3.5cm. From the followup, the external appearance of the thumbs looked nice, no limitation of joint motions was noticed and the pain sensation was recovered. The major improvement of this operation was that the donor skin was chosen from the dorsum of the first and second metacarpal bones, thus it was not necessary to divide the tendon of the extensor pollicis brevis, so that the operative procedure was simple and the postoperative functional recovery was rapid.
Objective To evaluate the cl inical efficacy of akin united flaps pedicled with dorsal carpal branch of ulnar artery in repairing compl icated degloving injuries of the opposite fingers. Methods Between August 2005 and August 2009, 11 cases of compl icated degloving injuries of single finger were treated, including 8 males and 3 females with an average age of 26 years (range, 19-55 years). The defect locations were thumb in 1 case, index finger in 7 cases, and middle finger in 3 cases, including 9 cases of mechanical injury and 2 cases of traffic accident injury. The extent of skin avulsion was the proximal segments or beyond the middle segment of finger with a defect range from 5.0 cm × 4.5 cm to 8.0 cm × 5.5 cm. Compl icated injuries included phalangeal fracture in 2 cases, extensor tendon injury in 3 cases, flexor and extensor tendon injuries in 1 case, digital vascular injury in 9 cases, and digital nerve injury in 6 cases. The time from injury to operation was 2-18 hours (mean, 4.8 hours). The akin united flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery. The proximally pedicled flaps enclosed palmar finger, and the distally pedicled flaps enclosed dorsal finger. The size of flaps ranged from 10 cm × 3 cm to 16 cm × 3 cm. The donor sites were sutured directly. After 3 weeks, the pedicle was cut. Results Light yellow secretion and eczema on the flap were observed in 1 case at 3 days, were cured after 2 weeks of dressing change; other flaps survived and healing of incisions by first intention was achieved. The incisions at donor sites healed by first intention. The secondary plastic operation was performed in 2 cases because of bulky flaps at 3 months after operation. Eleven patients were followed up postoperatively 6-12 months (8 months on average). The texture and appearance of all the flaps were satisfactory. The two-point discrimination was 12-20 mm with satisfactory recovery of finger function at 6 months after operation. According to Jebsen standard, the results were excellent in 8 cases, good in 2 cases, and poor in 1 case. Conclusion With rel iable blood supply, easy dissection, less injury at donor site, and good repair results, the akin united flaps pedicled with dorsal carpal branch ofulnar artery is a good method to repair complicated degloving injuries of the opposite fingers.
OBJECTIVE: To evaluate the function of injured hand after repair of finger stump and reconstruction of digit tendon attachment in finger amputation. METHODS: From 1992 to 1998, 20 cases with amputation of the 2nd to the 5th fingers were investigated, of which reconstruction of digit tendon attachment in 10 cases (group A) and routine operation without reconstruction of digit tendon attachment in other 10 cases (group B). After 6 months of operation, the tension test, fatigue test the sense of stability in motion and the perimeter of forearm in injured hand and the corresponding healthy hand were compared. RESULTS: The differences were remarkable (P lt; 0.01) between group A and group B in the tension test of injured finger, the fatigue test, the sense of stability in motion and the perimeter of injured arm. CONCLUSION: The digit of injured finger should be reconstructed in finger amputation in order to furthest maintain the function of injured hand.
Double adjacent-finger skin flap could be used to treat severe cicatricial contracture of fingers with resultant complete release of contracture and good coverage of raw surface. From the follow-up, it was noted that the appearance of the fingers following treatment looked nice, no recurrence of contracture in the late stage, and partial sensation of the fingers could be recovered as well. It had no ill-effect on the donor fingers, The method was simple and reliable,from 1987, a total of 4 cases had been done,and the functional recovery wassatisfactory.
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 choose the homodigital and the heterodigital flaps in the reconstruction of the distal finger injuries and to summarize the treatment results obtained in the clinical practice. Methods From August 2001 to June 2005, 112 injured fingers in 108 patients (68 males, 40 females; aged 16-63 years) were surgically treated. The injuries were due to remotion, crushing or avulsion, and they underwent operations 2 hours after the injuries. Nine kinds of flaps were taken from the dorsal or volar aspect of the injured fingers to cover the defects of the distal fingers. The flaps were divided into two kinds: ① The flaps were nourished by the main digital arterial branches, including the V-Y island flap based on the digital neurovascular bundles, the reversed digital artery flap, the modified Moberg flap, and the twins flaps based on the digital general neurovascular bundles (flaps ranging in area from 1.5 cm × 2.0 cm); and ② The flaps were nourished by the collateral digital arterial branches, including the dorsoulnar arterial retrograde flap of the thumb(flaps ranging in area from 1.5 cm×1.5 cm to 3.0 cm×2.5 cm) andthe reverse flap based on the dorsal branches of the digital artery (flaps ranging in area from 1.7 cm×1.0 cm to 4.5 cm×3.0 cm), the volar flap based on the transverse palmar branch of the digital artery (flaps ranging in area from 2.0 cm×1.0 cm to 2.5 cm×2.0 cm), and the island flap from the dorsum ofthe index finger and the digital local flaps. Results The follow-up for 2 weeks to 8 months revealed that all the flaps survived with an exception of flap necrosis in 3 patients and superficial necrosis in 3 patients. The sensation reached almost normal levels in the flaps based on collateral digital arteries and the twopoint discrimination was between 5 mm and 10 mm in the flaps based on the arterial branches. The finger motion ability was good and the finger appearance was satisfactory. Conclusion The choice of the above-mentioned skin flaps can repair the soft tissue defects of the distal parts of the fingers, which can have a satisfactory restoration contour.
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.
Objective To investigate the sensation of the fingers innervated by the brachial plexus roots and provide the theoretic basis for diagnosis of a brachial plexus injury. Methods From June 2003 to January 2005，10 patients (8 males, 2 females; age,18-47 years) with complete brachial plexus avulsion were involved in this study, who underwent thecontralateral C7 nerve root transfer. The latency and amplitude of the sensory nerve actiopotential(SNAP) were record at the C5 T1 nerve roots when stimulation was given at the fingers.Results When the thumb and the index finger were stimulated and SNAP was recorded at all the roots of the brachial plexus in all the patients, we found that there was a higher amplitude and a shorter latency at the C5-7 roots than at the C8 and T1 roots(P＜0.05). When the middle finger was stimulated and SNAP was recorded at the C7,8 and T1 roots, we found that there was the highest amplitude and the shortest laency at the C7 root(P＜0.01). When the ring finger was stimulated and SNAP was recorded at the C7,8and T1 roots, we found that there was a higher amplitude and a shorter latency at the C8 and T1 roots than at the C7 root(P＜0.01). When the little finger was stimulated and SNAP was recorded at the C7,8and T1 roots, we found that there was the highest amplitude and the shortest latency at the T1 root(P＜0.01). ConclusionThe sense of the thumband the index finger is mainly nnervated by the C5-7 roots, the middle finger sense is mainly innervated by the C7 root, the ring finger sense is mainly innervated by the C8 and T1 roots, and the little finger sense is mainly innervated by the T1 root.
ObjectiveTo investigate the decompression and diverting effects of vascular anastomosis based on the digital arterial arch branch in replantation of free finger-pulp in distal phalanges. MethodsA retrospective analysis was performed on the clinical data of 12 patients (12 fingers) who underwent free finger-pulp replantation with anastomosis of proper palmar digital artery and the palmar digital artery arch branch in the distal end between December 2004 and March 2015. Of 12 cases, 9 were male and 3 were female, aged 15-39 years with an average of 32 years. The causes of injury included cutting injury in 4 cases, crush injury in 7 cases, and avulsion injury in 1 case. The thumb was involved in 2 cases, index finger in 4 cases, ring finger in 3 cases, middle finger in 1 case, and little finger in 2 cases. The free finger pulp ranged from 1.8 cm×1.5 cm to 2.8 cm×2.0 cm. The time from injury to operation ranged from 1.5 to 11.0 hours, with an average of 5.7 hours. No arterial arch or proper palmar digital arteriae anastomosis was excluded. ResultsFree finger-pulp survived in 11 cases after operation; venous crisis occurred in 1 case at 2 days after operation, and was cured after symptomatic treatment. Nine cases were followed up 6-18 months with an average of 10 months. The finger-pulp had good appearance, clear fingerprint, and soft texture. The two-point discrimination was 3.1-6.0 mm, with an average of 4.6 mm at 6 months after operation. The function of finger flexion and extension was normal. And according to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, the results were excellent in 7 cases, and good in 2 cases. ConclusionIn the replantation of amputated pulp with insufficiency of venous blood outflow, the anastomosis of digital arterial arch branch in the distal end can decompress and shunt arterial blood, adjust blood inflow and outflow, and solve the problems of insufficient quantity of the vein and venous reflux disturbance.