Objective?To study the improved index finger dorsal island flap for primary repair of thumb tip injury.?Methods?Between January 2009 and February 2010, 23 patients with thumb tip injury were treated. There were 17 males and 6 females, aged 21-47 years (mean, 27.5 years). The causes of injury were mechanical injury in 18 cases and heavy crushing injury in 5 cases. The time from injury to operation was 2.5-5.0 hours (mean, 3.5 hours). The defect locations included ulnar palmar defect in 5 cases, dorsal foot defect in 6 cases, radial palmar defect in 8 cases, and radial dorsal defect in 4 cases. All patients complicated by exposure of the thumb distal phalanx. The wound area varied from 2.1 cm × 1.8 cm to 2.8 cm × 2.5 cm. According to distal soft tissue defect of thumb, a modified index finger dorsal island flap was designed, key point of which was moved forward, and defects were repaired with the flaps. The size of flap was 2.3 cm × 2.0 cm to 3.0 cm × 2.7 cm. The donor sites were repaired with skin graft.?Results?All the flaps and grafts survived after operation and the wounds healed by first intention. All patients were followed up 6-12 months with an average of 6.4 months. The appearance and texture of the flaps were excellent. At last follow-up, the sensation of the flaps recovered to S3+ in 18 cases, to S3 in 2 cases, and to S2 in 3 cases. The two-point discrimination was 3-4 mm. Thumb opposition function was normal without contracture at the first web space. The skin graft at the donor site survived completely, and the metacarpophalangeal joint at donor site had the flexion and extension function.?Conclusion?Using a modified index finger dorsal island flap for primary repair thumb tip injury is a simple operation, which has good blood supply and high survival rate. When the pedicle flap rotation point is moved forward 10 mm or more, it can meet the needs of repairing thumb tip defect.
Since 1992, the retrograde island skin flap with its pedicle containing the arteria pollicis dorsalis was used to repair 6 cases of the fingertip defects and the results were successful. The skin measured from 1.5cm x 2cm to 4cm x 3.5cm. From the followup, the external appearance of the thumbs looked nice, no limitation of joint motions was noticed and the pain sensation was recovered. The major improvement of this operation was that the donor skin was chosen from the dorsum of the first and second metacarpal bones, thus it was not necessary to divide the tendon of the extensor pollicis brevis, so that the operative procedure was simple and the postoperative functional recovery was rapid.
To investigate the operative method of repairing soft tissue defect of finger with modified reverse dorsal digital fascia flap and its cl inical effect of preventing and treating venous crisis. Methods From February 2005 to March 2007, 19 cases (22 fingers) with soft tissue defect of finger were treated, including 14 males (17 fingers) and 5 females (5 fingers) aged 2-62 years old (median 26 years old). There were 8 cases of cutting injury, 6 cases of crush injury, 4 cases of avulsion injury, and 1 case of hot crush injury, involving 3 thumbs, 7 index fingers, 6 middle fingers, 4 ring fingers and 2 l ittle fingers. The size of soft tissue defect was 1.5 cm × 0.8 cm-5.5 cm × 1.5 cm, and the time from injury to operation was 2-11 hours(average 7 hours). The axis of flaps was the l ine of transverse striation of fingers via dominant artery. The flaps were deflected dorsally, as “b” or “d”, to cover the wounds. Reverse dorsal digital fascia flaps 1.8 cm × 1.0 cm-6.0 cm × 2.0 cm in size were adopted to repair the defects. The donor site underwent skin grafting fixation. Results All flaps survived, without venous crisis and obvious swollen. The grafted skin in the donor site all survived. All patients were followed for 6-18 months (average 11 months). Postoperatively, color and texture of the grafted flaps were similar to that of normal skin, and the pulp of the fingers was normal. The two-point discrimination was 8-11 mm, and the activities of interphalangeal joint of all injured fingers were normal. Conclusion The modified reverse dorsal digital fascia flap is ideal for repairing soft tissues defects of the fingers, and can decrease the occurrence of venous crisis.
Objective?To investigate the surgical methods and clinical results of repairing soft tissue defects in the thumb with distally-based dorsal thumb neurocutaneous vascular flap.?Methods?From January 2006 to October 2007, 23 patients with soft tissue defect in the thumb were treated, including 20 males and 3 females aged 19-46 years old (average 27.5 years old). The defect was caused by crush injury in 1 case, electric planer accident in 6 cases, incised injury in 8 cases, and avulsion injury in 8 cases. The defect was located on the palmar aspect of the thumb distal phalanx in 3 cases, the dorsal-radial aspect of the thumb distal phalanx in 3 cases, and ulnar or dorsal aspect in 17 cases. The defect size ranged from 3.3 cm × 1.2 cm to 4.2 cm × 1.2 cm. Among them, 18 cases were complicated with distal 1/2 nail bed defect or injury. The time between injury and hospital admission was 1- 72 hours (average 22 hours). During operation, the defect was repaired with distally-based dorsal-radial neurovenocutaneous vascular flap of the thumb in 3 cases and distally-based dorsal-ulnar neurovenocutaneous vascular flap of the thumb in 20 cases. The size of those flaps was 4.0 cm × 1.6 cm-5.0 cm × 3.0 cm. The donor site underwent direct suture or split thickness skin graft repair.?Results?At 10 days after operation, 3 cases suffered from the epidermal necrosis in the distal part of the flap, 2 of them experienced the exfoliation of dark scab 14 days later and the flap survived, and the flap of the rest one survived after dressing change. The other flaps and the skin graft at the donor site all survived uneventfully. The wounds healed by first intention. All the patients were followed up for 10-16 months (average 12.6 months). The flaps were soft in texture and full in appearance. The two-point discrimination value 6 months after operation was 8-10 mm. At 12 months after operation, the growth of the residual fingernail was evident in 18 cases, including 4 cases of curved or hook fingernail. Active flexion and extension of the thumb were normal. The abduction of the first web space reached or surpassed 80 percent of the normal side in 20 cases and was below 80 percent of the normal side in 3 cases. The clinical outcomes were satisfactory in 11 cases, approximately satisfactory in 8 cases, and unsatisfactory in 4 cases according to self-designed evaluation system.?Conclusion?The operative method of repairing the soft tissue defects in the thumb with the distally-based dorsal thumb neurocutaneous vascular flap is simple, stable in anatomy, in line with the principle of proximity, and suitable for repairing thumb tip defect 3 cm in size. It can bring a good postoperative appearance of the thumb and little influence on the hand function.
