Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Wei ,  LIANG Gaofeng , ZHANG Manying , JIA Zhongyu , JIA Zonghai , DONG Junwen , DUAN Chaopeng , ZHI Feng , TENG Yunsheng , GUO Yongming

The First Department of Hand Surgery, 521 Hospital of Norinco Group, Xi’an Shaanxi, 710065, P. R. China;

Corresponding?author：

LIANG Gaofeng, Email: lgflgf4488@163.com

Keywords：

High-pressure injection injury; cross-finger flap; perforator flap; soft tissue defect

DOI：

10.7507/1002-1892.202305022

Video：

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Objective To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. Methods Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. Results All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. Conclusion The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.

Citation： ZHANG Wei, LIANG Gaofeng, ZHANG Manying, JIA Zhongyu, JIA Zonghai, DONG Junwen, DUAN Chaopeng, ZHI Feng, TENG Yunsheng, GUO Yongming. Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1138-1141. doi: 10.7507/1002-1892.202305022 Copy

1.	潘生德, 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.
2.	王濤, 顧玉東, 姜宗圓, 等. 手部高壓注射傷的治療. 中華手外科雜志, 2003, 19(4): 226-227.
3.	Rees CE. Penetration of tissue by fuel oil under high pressure from a diesel engine. JAMA, 1937, 19(11): 866-867.
4.	Eells AC, McRae M, Buntic RF, et al. High-pressure injection injury: a case report and systematic review. Case Reports Plast Surg Hand Surg, 2019, 6(1): 153-158.
5.	Feldman G, Rozen N, Eliyahu AC, et al. High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement. Hand Surg Rehabil, 2019, 38(5): 312-316.
6.	穆鈦飛, 王成, 陳世玖. 手部高壓注射傷的損傷機制與治療進展. 醫學綜述, 2021, 27(8): 1585-1590.
7.	Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma, 2006, 20(7): 503-511.
8.	謝松林, 唐舉玉, 陶克奇, 等. 指固有動脈背側支為蒂的逆行掌指背筋膜皮瓣的應用解剖. 中國臨床解剖學雜志, 2010, 28(1): 97-100.
9.	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. 中華顯微外科志, 2015, 38(2): 107-110.
10.	王志浩, 叢海波. 鄰指皮瓣臨床應用進展. 實用手外科雜志, 2013, 27(4): 392-393, 396.
11.	賈宗海, 梁高峰, 耿朝萌, 等. 攜帶隱神經終末支的游離足內側皮瓣在手部高壓注射傷中的應用. 中國修復重建外科雜志, 2020, 34(2): 270-271.
12.	羅小慶, 黃忠果. 鄰指指固有動脈背側支皮支鏈皮瓣修復手指軟組織缺損. 中華顯微外科雜志, 2016, 39(4): 398-399.
13.	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.

1. 潘生德, 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.
2. 王濤, 顧玉東, 姜宗圓, 等. 手部高壓注射傷的治療. 中華手外科雜志, 2003, 19(4): 226-227.
3. Rees CE. Penetration of tissue by fuel oil under high pressure from a diesel engine. JAMA, 1937, 19(11): 866-867.
4. Eells AC, McRae M, Buntic RF, et al. High-pressure injection injury: a case report and systematic review. Case Reports Plast Surg Hand Surg, 2019, 6(1): 153-158.
5. Feldman G, Rozen N, Eliyahu AC, et al. High-pressure injection injuries of the fingers: Long-term follow-up in patients after extensive debridement. Hand Surg Rehabil, 2019, 38(5): 312-316.
6. 穆鈦飛, 王成, 陳世玖. 手部高壓注射傷的損傷機制與治療進展. 醫學綜述, 2021, 27(8): 1585-1590.
7. Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma, 2006, 20(7): 503-511.
8. 謝松林, 唐舉玉, 陶克奇, 等. 指固有動脈背側支為蒂的逆行掌指背筋膜皮瓣的應用解剖. 中國臨床解剖學雜志, 2010, 28(1): 97-100.
9. 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. 中華顯微外科志, 2015, 38(2): 107-110.
10. 王志浩, 叢海波. 鄰指皮瓣臨床應用進展. 實用手外科雜志, 2013, 27(4): 392-393, 396.
11. 賈宗海, 梁高峰, 耿朝萌, 等. 攜帶隱神經終末支的游離足內側皮瓣在手部高壓注射傷中的應用. 中國修復重建外科雜志, 2020, 34(2): 270-271.
12. 羅小慶, 黃忠果. 鄰指指固有動脈背側支皮支鏈皮瓣修復手指軟組織缺損. 中華顯微外科雜志, 2016, 39(4): 398-399.
13. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger

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