REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGHuanyou ¹ ,  WANGBin ¹ , LUAidong ² , LIRuiguo ¹ , CHENChao ¹ , MATiepeng ¹

1. Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;
2. Department of Surgery, the Kailuan Hospital of Tangshan, Tangshan Hebei, 063000, P. R. China;

Corresponding?author：

WANGBin, Email: wbladyp3@sohu.com

Keywords：

Side island flap; Thumb pulp defect; Sensory reconstruction

DOI：

10.7507/1002-1892.20140190

Video：

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Objective To explore the effectiveness of the side island flap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects. Methods Between May 2008 and July 2012,36 cases of thumb pulp defects were treated with the side island flap coinciding dorsal branch of the digital nerve.There were 26 males and 10 females,aged 21-51 years (mean,32.4 years).The injury causes included electric saw injury in 14 cases,punch press injury in 8 cases,machine twist injury in 5 cases,door crushing injury in 5 cases,and glass cutting injury in 4 cases.The left hand was involved in 12 cases and the right hand in 24 cases.Combined injuries included tendon and bone exposure in all cases,fracture of the distal phalanx in 3 cases,and nail bed lacerations in 2 cases.The defect size ranged from 1.4 cm×1.2 cm to 2.5 cm×2.1 cm;and the flap size ranged from 1.8 cm×1.4 cm to 3.0 cm×2.5 cm. Results Two flaps with distal skin flap tension blisters and skin scabbing,which were cured after dressing changes;the wound healed by first intension in the other 34 cases.The skin grafts at donor site survived,and primary healing of incision was obtained.The patients were followed up 3-15 months (mean,8 months).The appearance and function restored well.Two-point discrimination of the flap was 5.2 mm on average (range,4-8 mm) at last follow-up.The finger joint had no stiff.According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,the sensation was S₄ in 33 and S_3⁺ in 3 cases.No ectopic feeling was observed.The extension and flexion activity of fingers at donor site was normal,the sensation reached S₄ with no atrophy of the finger. Conclusion With constant anatomy,reliable blood supply,and safe operation,the anastomoses of the finger side island flap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also effectively overcome the ectopic feeling with traditional methods and protect feel function of the fingers at donor site.

Citation： YANGHuanyou, WANGBin, LUAidong, LIRuiguo, CHENChao, MATiepeng. REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(7): 862-864. doi: 10.7507/1002-1892.20140190 Copy

1.	李慶泰,田光磊.手外科診斷學.2版.北京:人民衛生出版社,2009:257.
2.	張智,馬遠征,趙東升,等.帶神經鄰指近節指背逆行島狀皮瓣修復指腹缺損.中國修復重建外科雜志,2009,23(11):1397-1398.
3.	孫廣峰,王達利,魏在榮,等.拇指背側皮神經營養血管筋膜蒂逆行皮瓣修復拇指指腹缺損.中國修復重建外科雜志,2009,23(5):634-635.
4.	張志海,壽奎水,芮永軍,等.吻合神經的拇指背側皮神經營養血管皮瓣修復拇指腹缺損.中華手外科雜志,2006,22(5):270-271.
5.	鄭良軍,郭翱,李俊,等.指動脈背側支皮瓣游離移植修復指端缺損的療效評價.中華手外科雜志,2013,29(2):73-74.
6.	Zhang X,He Y,Shao X,et al.Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect.J Hand Surg (Am),2009,34(8):1467-1473.
7.	Shao X,Chen C,Zhang X,et al.Coverage of fingertip defect using a dorsal island pedicele flap including both dorsal digital nerves.J Hand Surg (Am),2009,34(8):1474-1481.
8.	徐衛東,李方奇,章祥州,等.拇指背側動脈逆行皮瓣修復電擊傷后拇指軟組織缺損.中華手外科雜志,2013,29(3):159-160.
9.	蔡若賦,周杰,黨書漢,等.超微型皮瓣在修復手指指端及指腹皮膚缺損中的應用.中華手外科雜志,2013,29(5):276.
10.	費劍榮,楊科躍,孫濤,等.游離大魚際肌穿支皮瓣修復指腹軟組織缺損.中華手外科雜志,2013,29(3):157-158.
11.	Tellioglu AT,Sensoz O.The dorsal branch of the digital nerve:an anatomic study and clinical applications.Ann Plast Surg,1998,40(2):145-148.
12.	邢丹謀,周必光,彭正人,等.指固有神經背側支的應用解剖學研究.中華手外科雜志,2001,17(1):52-54.
13.	趙民,邵新中,田德虎,等.指動脈背側支逆行筋膜蒂島狀皮瓣修復手指皮膚缺損.中國修復重建外科雜志,2005,19(6):453-454.
14.	潘達德,顧玉東,侍德,等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志,2000,16(3):130-135.
15.	Chen C,Zhang X,Shao X,et al.Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap.J Hand Surg (Am),2010,35(10):1663-1670.
16.	Littler JW.Neurovascular pedicle method of digital transposition for reconstruction of the thumb.Plast Reconstr Surg (1946),1953,12(5):303-319.
17.	譚旭昌,劉景臣.指固有動脈島狀皮瓣逆行修復指末節軟組織缺損.中華顯微外科雜志,2004,27(4):298-299.
18.	鄭文忠,陳昆,蘇鴻君,等.手指近端微型島狀皮瓣修復指腹缺損.中華顯微外科雜志,2009,32(2):151.
19.	高順紅,陳超,孫來卿,等.手指皮膚缺損的顯微外科修復.中華顯微外科雜志,2011,34(3):227-229.
20.	侯春林.帶血管蒂組織瓣移位手術圖解.2版.上海:上海科學技術出版社,1997:114.
21.	李啟超,張雙喜,陳振喜,等.指固有神經背側支移位重建指腹感覺功能.中華手外科雜志,2011,27(1):33-34.

1. 李慶泰,田光磊.手外科診斷學.2版.北京:人民衛生出版社,2009:257.
2. 張智,馬遠征,趙東升,等.帶神經鄰指近節指背逆行島狀皮瓣修復指腹缺損.中國修復重建外科雜志,2009,23(11):1397-1398.
3. 孫廣峰,王達利,魏在榮,等.拇指背側皮神經營養血管筋膜蒂逆行皮瓣修復拇指指腹缺損.中國修復重建外科雜志,2009,23(5):634-635.
4. 張志海,壽奎水,芮永軍,等.吻合神經的拇指背側皮神經營養血管皮瓣修復拇指腹缺損.中華手外科雜志,2006,22(5):270-271.
5. 鄭良軍,郭翱,李俊,等.指動脈背側支皮瓣游離移植修復指端缺損的療效評價.中華手外科雜志,2013,29(2):73-74.
6. Zhang X,He Y,Shao X,et al.Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect.J Hand Surg (Am),2009,34(8):1467-1473.
7. Shao X,Chen C,Zhang X,et al.Coverage of fingertip defect using a dorsal island pedicele flap including both dorsal digital nerves.J Hand Surg (Am),2009,34(8):1474-1481.
8. 徐衛東,李方奇,章祥州,等.拇指背側動脈逆行皮瓣修復電擊傷后拇指軟組織缺損.中華手外科雜志,2013,29(3):159-160.
9. 蔡若賦,周杰,黨書漢,等.超微型皮瓣在修復手指指端及指腹皮膚缺損中的應用.中華手外科雜志,2013,29(5):276.
10. 費劍榮,楊科躍,孫濤,等.游離大魚際肌穿支皮瓣修復指腹軟組織缺損.中華手外科雜志,2013,29(3):157-158.
11. Tellioglu AT,Sensoz O.The dorsal branch of the digital nerve:an anatomic study and clinical applications.Ann Plast Surg,1998,40(2):145-148.
12. 邢丹謀,周必光,彭正人,等.指固有神經背側支的應用解剖學研究.中華手外科雜志,2001,17(1):52-54.
13. 趙民,邵新中,田德虎,等.指動脈背側支逆行筋膜蒂島狀皮瓣修復手指皮膚缺損.中國修復重建外科雜志,2005,19(6):453-454.
14. 潘達德,顧玉東,侍德,等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志,2000,16(3):130-135.
15. Chen C,Zhang X,Shao X,et al.Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap.J Hand Surg (Am),2010,35(10):1663-1670.
16. Littler JW.Neurovascular pedicle method of digital transposition for reconstruction of the thumb.Plast Reconstr Surg (1946),1953,12(5):303-319.
17. 譚旭昌,劉景臣.指固有動脈島狀皮瓣逆行修復指末節軟組織缺損.中華顯微外科雜志,2004,27(4):298-299.
18. 鄭文忠,陳昆,蘇鴻君,等.手指近端微型島狀皮瓣修復指腹缺損.中華顯微外科雜志,2009,32(2):151.
19. 高順紅,陳超,孫來卿,等.手指皮膚缺損的顯微外科修復.中華顯微外科雜志,2011,34(3):227-229.
20. 侯春林.帶血管蒂組織瓣移位手術圖解.2版.上海:上海科學技術出版社,1997:114.
21. 李啟超,張雙喜,陳振喜,等.指固有神經背側支移位重建指腹感覺功能.中華手外科雜志,2011,27(1):33-34.

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REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE

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