Objective To investigate the sensation of the fingers innervated by the brachial plexus roots and provide the theoretic basis for diagnosis of a brachial plexus injury. Methods From June 2003 to January 2005，10 patients (8 males, 2 females; age,18-47 years) with complete brachial plexus avulsion were involved in this study, who underwent thecontralateral C7 nerve root transfer. The latency and amplitude of the sensory nerve actiopotential(SNAP) were record at the C5 T1 nerve roots when stimulation was given at the fingers.Results When the thumb and the index finger were stimulated and SNAP was recorded at all the roots of the brachial plexus in all the patients, we found that there was a higher amplitude and a shorter latency at the C5-7 roots than at the C8 and T1 roots(P＜0.05). When the middle finger was stimulated and SNAP was recorded at the C7,8 and T1 roots, we found that there was the highest amplitude and the shortest laency at the C7 root(P＜0.01). When the ring finger was stimulated and SNAP was recorded at the C7,8and T1 roots, we found that there was a higher amplitude and a shorter latency at the C8 and T1 roots than at the C7 root(P＜0.01). When the little finger was stimulated and SNAP was recorded at the C7,8and T1 roots, we found that there was the highest amplitude and the shortest latency at the T1 root(P＜0.01). ConclusionThe sense of the thumband the index finger is mainly nnervated by the C5-7 roots, the middle finger sense is mainly innervated by the C7 root, the ring finger sense is mainly innervated by the C8 and T1 roots, and the little finger sense is mainly innervated by the T1 root.
The traditional Kutler and Atasoy V-Y advancement flaps have minimal advancement degree, did not satisfy to repair large skin defect in fingers, hence, have no wide indications. The sensory function of the fingers to be influenced because of injury of sensory nerves and sear formation. Since 1985 to 1991, the V-Y advancement flaps pedicled by bilateral digital arteries and nerves have been used for reconstruction of 33 finger tip defect and 5 digital volar skin contraction. All of these cases obtained satisfactory function and excellent appearance.In this paper, the anatomical charactistics and principles of devicerecommended, the advantages and key points to success discussed.
To summarize the results of the free transplantation of anti-valve-inflow and pro-valveoutflow arterial ized venous flap in repairing soft tissue defect of fingers in emergency treatment. Methods From October 2002 to March 2007, 7 cases of soft tissue defects of fingers were repaired with arterial ized venous flaps. There were 6 males and 1 female, aged 17-46 years. Defect was caused by crush injury in 6 cases and by stab injury in 1 case. The interval between injuryand operation was 2-7 hours and the size of defects ranged from 3.0 cm × 2.0 cm to 6.0 cm × 3.5 cm. All defects were repaired by arterial ized free venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The donor site was directly sutured. Results Six cases of arterial ized venous flap survived completely and 1 case had partial superficial necrosis and healed with conservative management. The donor site healed by first intention. Postoperative follow-up ranged from 3 months to 4 years, the texture and the thickness of the flaps were satisfactory, only one presented partial pigment deposits because of superficial necrosis. No sclerosis, contracture and l imited range of motion occurred in all flaps. According to the evaluation criteria for upper l imb function issued by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 3 cases and good in 4 cases. Conclusion It is an ideal method to repair soft tissue defect of fingers by using anti-valve-inflow and pro-valve-outflow arterial ized venous flap.
ObjectiveTo evaluate the surgical technique and the effectiveness of the free superficial palmar branch of the radial artery flap to repair soft tissue defect of fingers.MethodsBetween June 2014 and June 2017, 10 cases (10 fingers) of soft tissue defects of fingers were repaired with the free superficial palmar branch of the radial artery flaps. There were 8 males and 2 females with an average age of 29.8 years (range, 23-42 years). The causes of injury included the chainsaw cutting injury in 6 cases, the machine crush injury in 2 cases, and the glass scratching in 2 cases. The time from injury to admission was 1-8 hours with an average of 3 hours. The locations were the volar of the middle of index finger in 3 cases, the volar of the distal of index finger in 1 case, the volar of the distal of middle finger in 3 cases, the ulnar side of distal interphalangeal joint of ring finger in 1 case, and the volar of the distal of the little finger in 2 cases. The area of soft tissue defect ranged from 1.8 cm×0.9 cm to 2.8 cm×2.1 cm, and the area of flap ranged from 2.0 cm×1.0 cm to 3.0 cm×2.3 cm. The donor sites were sutured directly.ResultsAll flaps survived after operation, and the wounds healed by first intention. The incisions of donor site also healed by first intention with a linear scar. All cases were followed up 6-12 months (mean, 9 months). The appearance and texture of the flaps were satisfactory. The pain sensation, warm sensation, and touch sensation of the flap recovered. At last follow-up, the two-point discrimination of the flap was 6-13 mm (mean, 7.5 mm). According to the assessment of the upper limb function issued by tha Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 8 cases and good in 2 cases.ConclusionThe free superficial palmar branch of the radial artery flap is easy to harvest and anastomose and has small injury. It is an ideal method in repairing of soft tissue defects of fingers.
