Free transplantation of medial plantar Flow-through venous flap for primary repairing children’s finger wounds with digital artery defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jian , ZHENG Yucen ,  WEI Zairong , NIE Kaiyu , XIAO Shun’e , HUANG Guangtao , LIU Zhiyuan , LI Hai , JIN Wenhu , CHEN Wei

Department of Burn and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China;

Corresponding?author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

Medial plantar; Flow-through venous flap; child; finger; wound repair

DOI：

10.7507/1002-1892.202104101

Video：

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Objective To explore the feasibility and effectiveness of free transplantation of medial plantar Flow-through venous flap for primary repairing children’s finger wounds with digital artery defect.Methods Between July 2016 and October 2020, 9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap. There were 6 boys and 3 girls, with an average age of 6.8 years (range, 4-13 years). The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases. Among them, there were 3 cases of index finger wounds, 3 cases of middle finger wounds, 2 cases of ring finger wounds, and 1 case of little finger wounds. The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm. The time from injury to operation was 1.3-8.6 hours, with an average of 4.8 hours. The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm. After the flaps were inverted, the veins were used to bridge the finger arteries while repairing the wounds. The donor site of the foot was sutured directly in 4 cases, and repaired with full-thickness skin grafts in 5 cases.Results All flaps survived, and hand wounds healed by first intention; 8 cases of foot donor site wounds healed by first intention, and 1 case had partial necrosis in the marginal area of the skin graft, which healed after dressing change. All 9 children were followed up 3-24 months, with an average of 9 months. The color and texture of the flap were similar to those of the surrounding normal skin, and the protective feeling was restored. The two-point discrimination of the flap was 7-10 mm, with an average of 8 mm. At last follow-up, according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association, the finger function was excellent in 5 cases and good in 4 cases. There was no ulcer formation and scar hyperplasia in the foot donor site, which did not affect walking.Conclusion The free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children’s finger wounds with digital artery defect. It has the advantages of simple flap extraction, thin flap, similar color and texture to the skin of the hand, and concealed donor site.

Citation： ZHOU Jian, ZHENG Yucen, WEI Zairong, NIE Kaiyu, XIAO Shun’e, HUANG Guangtao, LIU Zhiyuan, LI Hai, JIN Wenhu, CHEN Wei. Free transplantation of medial plantar Flow-through venous flap for primary repairing children’s finger wounds with digital artery defect. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(9): 1182-1185. doi: 10.7507/1002-1892.202104101 Copy

1.	Wolff KD, Dollinger P. Hemoglobin oxygenation of venous-perfused forearm flaps. Ann Plast Surg, 1998, 41(6): 646-652.
2.	陳華勇, 楊鎮洙. 動脈化靜脈皮瓣血液循環途徑的實驗研究. 中華顯微外科雜志, 1997, 30(2): 130-131.
3.	李瑞華, 闞世廉, 許效坤, 等. 動脈化靜脈皮瓣兩種灌流方式比較的實驗研究及臨床應用. 中華手外科雜志, 2006, 22(4): 242-244.
4.	陳飛, 劉銘波, 王克列. 游離靜脈皮瓣修復手指末節軟組織缺損. 齊齊哈爾醫學院學報, 2012, 33(22): 3075-3076.
5.	陳祿, 黃文柱, 楊俊貴, 等. 前臂動脈化靜脈皮瓣解剖分型、特點及臨床應用. 中華顯微外科雜志, 2015, 38(6): 574-578.
6.	鄭大偉, 黎章燦, 許立, 等. Flow-through 靜脈皮瓣在復雜性斷指再植中的應用. 中華顯微外科雜志, 2015, 38(1): 25-28.
7.	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.
8.	李濤, 陳振兵, 叢曉斌, 等. 鄰指指動脈 Flow-through 皮瓣橋接斷指血運的臨床應用. 中華顯微外科雜志, 2014, 37(1): 10-12.
9.	李祥軍, 巨積輝, 劉海亮, 等. 游離第二趾脛側血流橋接皮瓣修復伴指動脈缺損的手指創面. 中華手外科雜志, 2017, 33(5): 355-357.
10.	唐俊華, 全國棟, 曾永文, 等. Flow-through 尺動脈腕上支穿支皮瓣在伴指掌側固有動脈缺損創面中的應用. 中華顯微外科雜志, 2021, 44(1): 77-79.
11.	侯橋, 辛大偉, 全仁夫, 等. 橈動脈掌淺支 Flow-through 皮瓣橋接修復合并血管及軟組織缺損的斷指再植. 中華顯微外科雜志, 2019, 42(4): 326-329.
12.	呂文濤, 巨積輝, 蔣國棟, 等. 血流橋接型靜脈皮瓣修復伴有指掌側固有動脈缺缺的手指創面. 中華顯微外科雜志, 2018, 41(1): 40-43.
13.	尹成國, 王業本, 姚保兵, 等. 游離足底內側靜脈皮瓣在手指軟組織缺損中的應用. 中華手外科雜志, 2014, 30(6): 470-472.
14.	Kawakatsu M. Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation. J Plast Reconstr Aesthet Surg, 2019, 72(3): 459-466.
15.	周健, 魏在榮, 孫廣峰, 等. 游離第 3 足趾脛側微型皮瓣修復手指末節指腹皮膚軟組織缺損. 中華燒傷雜志, 2019, 35(3): 205-208.
16.	汪春陽, 柴益民, 程天慶, 等. 吻合血管的足內側穿支皮瓣的應用解剖與臨床應用. 中華顯微外科雜志, 2010, 33(1): 3-5, 89.
17.	王海文, 顧榮, 江新民, 等. 足底內側動脈穿支皮瓣修復手部掌側皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(5): 486-488.
18.	梁高峰, 張偉, 段超鵬, 等. 游離足底內側 Flow-through 皮瓣修復手指軟組織缺損 12 例. 中華顯微外科雜志, 2019, 42(4): 411-413.
19.	Goldberg J, Sepka RS, Perona BP, et al. Laser Doppler blood flow measurements of common cutaneous donor sites for reconstructive surgery. Plast Reconstr Surg, 1990, 85(4): 581-586.
20.	Orenstein A, Mazkereth R, Tsur H. Mapping of the human body skin with the transcutaneous oxygen pressure method. Ann Plast Surg, 1988, 20(5): 419-425.
21.	Yoon ES, Kim DW, Chun D, et al. An anatomic study and clinical application of medial pedis flap in Asians. Ann Plast Surg, 2007, 58(5): 517-522.
22.	劉興坤, 張永福, 廖健興, 等. 嬰幼兒皮膚毛細血管密度的區域性差異——酶組織化學結合體視學研究. 中華整形燒傷外科雜志, 1998, 14(6): 448-451, C24.
23.	孫文海, 王增濤, 仇申強, 等. 足底內側靜脈皮瓣修復指掌側軟組織缺損. 中國修復重建外科雜志, 2010, 24(1): 50-52.

1. Wolff KD, Dollinger P. Hemoglobin oxygenation of venous-perfused forearm flaps. Ann Plast Surg, 1998, 41(6): 646-652.
2. 陳華勇, 楊鎮洙. 動脈化靜脈皮瓣血液循環途徑的實驗研究. 中華顯微外科雜志, 1997, 30(2): 130-131.
3. 李瑞華, 闞世廉, 許效坤, 等. 動脈化靜脈皮瓣兩種灌流方式比較的實驗研究及臨床應用. 中華手外科雜志, 2006, 22(4): 242-244.
4. 陳飛, 劉銘波, 王克列. 游離靜脈皮瓣修復手指末節軟組織缺損. 齊齊哈爾醫學院學報, 2012, 33(22): 3075-3076.
5. 陳祿, 黃文柱, 楊俊貴, 等. 前臂動脈化靜脈皮瓣解剖分型、特點及臨床應用. 中華顯微外科雜志, 2015, 38(6): 574-578.
6. 鄭大偉, 黎章燦, 許立, 等. Flow-through 靜脈皮瓣在復雜性斷指再植中的應用. 中華顯微外科雜志, 2015, 38(1): 25-28.
7. 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.
8. 李濤, 陳振兵, 叢曉斌, 等. 鄰指指動脈 Flow-through 皮瓣橋接斷指血運的臨床應用. 中華顯微外科雜志, 2014, 37(1): 10-12.
9. 李祥軍, 巨積輝, 劉海亮, 等. 游離第二趾脛側血流橋接皮瓣修復伴指動脈缺損的手指創面. 中華手外科雜志, 2017, 33(5): 355-357.
10. 唐俊華, 全國棟, 曾永文, 等. Flow-through 尺動脈腕上支穿支皮瓣在伴指掌側固有動脈缺損創面中的應用. 中華顯微外科雜志, 2021, 44(1): 77-79.
11. 侯橋, 辛大偉, 全仁夫, 等. 橈動脈掌淺支 Flow-through 皮瓣橋接修復合并血管及軟組織缺損的斷指再植. 中華顯微外科雜志, 2019, 42(4): 326-329.
12. 呂文濤, 巨積輝, 蔣國棟, 等. 血流橋接型靜脈皮瓣修復伴有指掌側固有動脈缺缺的手指創面. 中華顯微外科雜志, 2018, 41(1): 40-43.
13. 尹成國, 王業本, 姚保兵, 等. 游離足底內側靜脈皮瓣在手指軟組織缺損中的應用. 中華手外科雜志, 2014, 30(6): 470-472.
14. Kawakatsu M. Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation. J Plast Reconstr Aesthet Surg, 2019, 72(3): 459-466.
15. 周健, 魏在榮, 孫廣峰, 等. 游離第 3 足趾脛側微型皮瓣修復手指末節指腹皮膚軟組織缺損. 中華燒傷雜志, 2019, 35(3): 205-208.
16. 汪春陽, 柴益民, 程天慶, 等. 吻合血管的足內側穿支皮瓣的應用解剖與臨床應用. 中華顯微外科雜志, 2010, 33(1): 3-5, 89.
17. 王海文, 顧榮, 江新民, 等. 足底內側動脈穿支皮瓣修復手部掌側皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(5): 486-488.
18. 梁高峰, 張偉, 段超鵬, 等. 游離足底內側 Flow-through 皮瓣修復手指軟組織缺損 12 例. 中華顯微外科雜志, 2019, 42(4): 411-413.
19. Goldberg J, Sepka RS, Perona BP, et al. Laser Doppler blood flow measurements of common cutaneous donor sites for reconstructive surgery. Plast Reconstr Surg, 1990, 85(4): 581-586.
20. Orenstein A, Mazkereth R, Tsur H. Mapping of the human body skin with the transcutaneous oxygen pressure method. Ann Plast Surg, 1988, 20(5): 419-425.
21. Yoon ES, Kim DW, Chun D, et al. An anatomic study and clinical application of medial pedis flap in Asians. Ann Plast Surg, 2007, 58(5): 517-522.
22. 劉興坤, 張永福, 廖健興, 等. 嬰幼兒皮膚毛細血管密度的區域性差異——酶組織化學結合體視學研究. 中華整形燒傷外科雜志, 1998, 14(6): 448-451, C24.
23. 孫文海, 王增濤, 仇申強, 等. 足底內側靜脈皮瓣修復指掌側軟組織缺損. 中國修復重建外科雜志, 2010, 24(1): 50-52.

Chinese Journal of Reparative and Reconstructive Surgery

Free transplantation of medial plantar Flow-through venous flap for primary repairing children’s finger wounds with digital artery defect

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