Application of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANG Huanyou , WANG Bin , HUANG Lei , LI Jingsong , WANG Wei

The First Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China;

Corresponding?author：

YANG Huanyou, Email: yanghuanyou123@126.com

Keywords：

Finger injury; digital proper artery dorsal branch flap; degloving injury; wound repair

DOI：

10.7507/1002-1892.201804055

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Objective To investigate the effectiveness of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Methods Between February 2013 and July 2016, 11 cases (11 fingers) of mid-phalanx degloving injury with distal segment finger defect were treated. There were 9 males and 2 females with an average age of 33.6 years (range, 18-59 years). The injury caused by twisting in 8 cases and crushing in 3 cases. The injury located at index finger in 3 cases, middle finger in 6 cases, and ring finger in 2 cases. The skin avulsion was from proximal interphalangeal joint in 1 case, proximal 1/4 of mid-phalanx in 6 cases, and 1/2 of mid-phalanx in 4 cases. The area of wounds ranged from 4.0 cm×1.7 cm to 6.2 cm×2.6 cm. The interval between injury and operation was 2.5-6.0 hours (mean, 4.5 hours). All defects were repaired with the ipsilateral digital proper artery dorsal branch flaps. The size of flaps ranged from 4.4 cm×1.9 cm to 7.0 cm×2.9 cm. Nerve anastomose was carried between digital proper nerve dorsal branch in the flap and digital proper nerve stump in the wound. The donor sites were repaired by skin grafting. Results Tension blisters of the flap and partial necrosis occurred in 1 case, and healed after dressing change. The other flaps and skin grafting survived, and wounds healed by first intention. All patients were followed up 6-18 months (mean, 16 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination of flaps ranged from 7 to 10 mm (mean, 8.5 mm). At last follow-up, according to the functional assessment criteria of upper limbs by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 10 cases and good in 1 case, with the excellent and good rate of 100%. Conclusion The ipsilateral digital proper artery dorsal branch flap is a good method to repair mid-phalanx degloving injury with distal segment finger defect for the advantages of simple operation, less damage in donor site, high survival rate of the flap, and good feeling recovery of the finger.

Citation： YANG Huanyou, WANG Bin, HUANG Lei, LI Jingsong, WANG Wei. Application of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1446-1449. doi: 10.7507/1002-1892.201804055 Copy

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2.	潘達德, 顧玉東, 侍德. 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.
3.	盧耀軍, 周福臨. 帶蒂腹部分層組織瓣結合自體皮移植一期修復手部皮膚脫套傷. 中華顯微外科雜志, 2015, 38(2): 180-182.
4.	王懷璽, 左中男, 于紹斌, 等. 應用帶掌背神經的掌背動脈皮瓣修復手指脫套傷. 中華顯微外科雜志, 2013, 36(2): 198-200.
5.	強力, 薛明宇, 沈小芳, 等. 游離" M”形骨間背分葉肌皮瓣修復手指中末節脫套傷. 中華顯微外科雜志, 2015, 38(2): 184-186.
6.	姚群, 芮永軍, 壽奎水, 等. 游離尺動脈腕上穿支皮瓣修復套脫傷. 中華手外科雜志, 2014, 30(6): 411-413.
7.	沈鴻飛, 岳震雙, 湯樣華, 等. 第二趾脛側皮瓣與?趾趾背皮瓣瓦合修復手指II度套脫傷. 中華手外科雜志, 2016, 32(6): 425-426.
8.	周建輝, 李秀文, 王夫平, 等. ?甲皮瓣聯合第二足趾脛側皮瓣修復手指末節脫套傷. 中華顯微外科雜志, 2015, 38(5): 516-517.
9.	Braga-Silva J, Kuyven CR, Fallopa F, et al. An anatomical study of the dorsal cutaneous branches of digital arteries. J Hand Surg (Br), 2002, 27(6): 577-579.
10.	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.
11.	張文龍, 趙剛, 馬愛國, 等. 指掌側固有動脈背側支皮瓣的顯微解剖與臨床應用. 中華顯微外科雜志, 2015, 38(2): 107-110.
12.	張劍鋒, 胡永成, 王斌, 等. 同指" 雙峰樣”皮瓣修復手指遠節套脫傷. 中華手外科雜志, 2017, 33(3): 184-186.
13.	徐達傳. 手功能修復重建外科解剖學. 北京: 人民衛生出版社, 1996: 121-123.
14.	李海, 鄧呈亮, 魏在榮, 等. 分葉股前外側穿支皮瓣在血管蒂保護中的作用研究. 中國修復重建外科雜志, 2017, 31(10): 1245-1249.
15.	王培吉, 周忠良, 江波. 掌背動脈皮支蒂逆行筋膜皮瓣修復手指皮膚缺損. 中華手外科雜志, 2010, 26(1): 195-197.
16.	張文龍, 張文靜, 杜曉松, 等. 指動脈背側支皮瓣修復鄰指皮膚缺損. 中華手外科雜志, 2014, 30(1): 66-68.
17.	楊林, 劉宏君, 張文忠, 等. 改良股前外側游離穿支皮瓣橋式交叉移植修復小腿中下段軟組織缺損. 中國修復重建外科雜志, 2017, 31(10): 1240-1244.

1. 芮永軍, 施海峰, 邱揚, 等. 不同構制的?甲瓣修復手指脫套傷. 中華手外科雜志, 2007, 23(6): 349-351.
2. 潘達德, 顧玉東, 侍德. 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.
3. 盧耀軍, 周福臨. 帶蒂腹部分層組織瓣結合自體皮移植一期修復手部皮膚脫套傷. 中華顯微外科雜志, 2015, 38(2): 180-182.
4. 王懷璽, 左中男, 于紹斌, 等. 應用帶掌背神經的掌背動脈皮瓣修復手指脫套傷. 中華顯微外科雜志, 2013, 36(2): 198-200.
5. 強力, 薛明宇, 沈小芳, 等. 游離" M”形骨間背分葉肌皮瓣修復手指中末節脫套傷. 中華顯微外科雜志, 2015, 38(2): 184-186.
6. 姚群, 芮永軍, 壽奎水, 等. 游離尺動脈腕上穿支皮瓣修復套脫傷. 中華手外科雜志, 2014, 30(6): 411-413.
7. 沈鴻飛, 岳震雙, 湯樣華, 等. 第二趾脛側皮瓣與?趾趾背皮瓣瓦合修復手指II度套脫傷. 中華手外科雜志, 2016, 32(6): 425-426.
8. 周建輝, 李秀文, 王夫平, 等. ?甲皮瓣聯合第二足趾脛側皮瓣修復手指末節脫套傷. 中華顯微外科雜志, 2015, 38(5): 516-517.
9. Braga-Silva J, Kuyven CR, Fallopa F, et al. An anatomical study of the dorsal cutaneous branches of digital arteries. J Hand Surg (Br), 2002, 27(6): 577-579.
10. 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.
11. 張文龍, 趙剛, 馬愛國, 等. 指掌側固有動脈背側支皮瓣的顯微解剖與臨床應用. 中華顯微外科雜志, 2015, 38(2): 107-110.
12. 張劍鋒, 胡永成, 王斌, 等. 同指" 雙峰樣”皮瓣修復手指遠節套脫傷. 中華手外科雜志, 2017, 33(3): 184-186.
13. 徐達傳. 手功能修復重建外科解剖學. 北京: 人民衛生出版社, 1996: 121-123.
14. 李海, 鄧呈亮, 魏在榮, 等. 分葉股前外側穿支皮瓣在血管蒂保護中的作用研究. 中國修復重建外科雜志, 2017, 31(10): 1245-1249.
15. 王培吉, 周忠良, 江波. 掌背動脈皮支蒂逆行筋膜皮瓣修復手指皮膚缺損. 中華手外科雜志, 2010, 26(1): 195-197.
16. 張文龍, 張文靜, 杜曉松, 等. 指動脈背側支皮瓣修復鄰指皮膚缺損. 中華手外科雜志, 2014, 30(1): 66-68.
17. 楊林, 劉宏君, 張文忠, 等. 改良股前外側游離穿支皮瓣橋式交叉移植修復小腿中下段軟組織缺損. 中國修復重建外科雜志, 2017, 31(10): 1240-1244.

Chinese Journal of Reparative and Reconstructive Surgery

Application of ipsilateral digital proper artery dorsal branch flap to repair mid-phalanx degloving injury with distal segment finger defect

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