Chinese Journal of Reparative and Reconstructive Surgery
Supervisor： National Health Commission of the People's Republic of ChinaSponsor： Chinese Association of Rehabilitation Medicine , Sichuan University Editor-in-chief：Bin Shen Publishing period：
Monthly
ISSN：1002-1892CN：51-1372/R
Objective To investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect.
Methods Between January 2010 and December 2012,11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps.There were 8 males and 3 females,aged 18-42 years (mean,24.6 years).The cause of injury was squeeze injury in 6 cases,crush injury in 3 cases,and strangulation in 2 cases.Combined injuries included nerve defect in 3 cases (1.0,2.0,and 3.5 cm in length),and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width,was 1/2-1 finger circumference in length,and was 2.0 cm×1.0 cm to 7.0 cm×4.5 cm in size.Six cases had complete circular defect (both finger artery and vein defects),and 5 cases had incomplete circular defect (only finger artery defect),and vascular defect was 1.0-4.5 cm in length.The time from injury to operation was 1.5-4.5 hours.
Results Venous crisis occurred in 1 case at 2 days after operation,was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously.The other 6 flaps and replanted fingers survived completely,with primary healing of incision.Ten cases were followed up 12-18 months (mean,15.5 months).Only a linear scar was seen at the donor sites,with no functional limitation.The flaps had similar color and texture to adjacent skin.The two-point discrimination was 6.5-13.0 mm (mean,8.6 mm).According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association,the results were excellent in 6 cases,good in 3 cases,and poor in 1 case at last follow-up,and the excellent and good rate was 90%.
Conclusion Venous Flow-through flap can repair both vascular defect and soft tissue defect,so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.
Citation：ZHENGDawei, LIZhangcan, XULi, ZHANGXuyang, SHIRongjian, SUNFeng, SHOUKuishui. APPLICATION OF VENOUS Flow-through FLAP IN FINGER REPLANTATION WITH CIRCULARITY SOFT TISSUE DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 977-980. doi: 10.7507/1002-1892.20140215Copy
Copyright ? the editorial department of Chinese Journal of Reparative and Reconstructive Surgery of West China Medical Publisher. All rights reserved
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14. Brooks D,Buntic RF,Taylor C.Use of the venous flap for salvage of difficult ring avulsion injuries.Microsurgery,2008,28(6):397-402.
15. Lin YH,Jeng CH,Hsieh CH,et al.Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton:a case report.Microsurgery,2010,30(6):469-471.
16. George P,DeJesus RA.Venous flow-through flap reconstruction following severe finger wound infection:case report.J Reconstr Microsurg,2009,25(4):267-269.
17. Woo SH,Kim KC,Lee GJ,et al.A retrospective analysis of 154 arterialized venous flaps for hand reconstruction:an 11-year experience.Plast Reconstr Surg,2007,119(6):1823-1838.
18. Hyza P,Vesely J,Novák P,et al.Arterialized venous free flaps-a reconstructive alternative for large dorsal digital defects.Acta Chir Plast,2008,50(2):43-50.
19. Lin YT,Henry SL,Lin CH,et al.The shunt-restricted arterialized venous flap for hand/digit reconstruction:Enhanced perfusion,decreased congestion,and improved reliability.J Trauma,2010,69(2):399-404.
20. Yan H,Brooks D,Ladner R,et al.Arterialized venous flaps:a review of the literature.Microsurgery,2010,30(6):472-478.
21. Goldschlager R,Rozen WM,Ting JW,et al.The nomenclature of venous flow-through flaps:updated classification and review of the literature.Microsurgery,2012,32(6):497-501.
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