Objective?To investigate the effectiveness of the island flap pedicled with the dorsal cutaneous branches of thumb radial digital artery from the same finger for repairing pulp defect.?Methods?Between June 2009 and March 2010, 10 patients (10 fingers) with pulp defect of thumb were treated. There were 6 males and 4 females, aged 13-68 years with an average of 38 years. Defect was caused by machine crush in 4 cases, by saw machine in 3 cases, by chronic infection in 2 cases, and by burn in 1 case. The disease duration was 3 hours to 4 months. In 4 cases of distal pulp defect (1.0 cm × 0.8 cm to 2.0 cm × 1.4 cm) with exposure of bone or tendon, defect was repaired with island flap pedicled with the interphalangeal joint cutaneous branches of thumb radial digital artery (1.0 cm × 0.8 cm to 2.2 cm× 1.5 cm). In 6 cases of proximal pulp defect (1.0 cm × 0.8 cm to 2.5 cm × 2.0 cm) with exposure of bone or tendon, defect was repaired with island flap pedicled with the metacarpophalangeal joint cutaneous branches of thumb radial digital artery (1.0 cm × 0.8 cm to 2.6 cm × 2.2cm). The donor sites were repaired with skin grafts.?Results?All flaps and skin grafts survived, and wounds healed by first intention. Ten cases were followed up 6-12months (mean, 8 months). The colour, texture, and contour of the flaps were good. The two-point discrimination was 7-10mm on the island flap at last follow-up. According to total active motion (TAM) standard, the thumb function was assessed as excellent in 8 cases, good in 1 case, and fair in 1 case, and the excellent and good rate was 90%.?Conclusion?The main digital artery and nerve of thumb will not be sacrified when the island flap pedicled with the dorsal cutaneous branches of thumb radial digital artery is used. The operative procedure is simple, so it is a good method for repairing pulp defect of thumb.
Objective To observe the clinical effects of neurovascular island flap from the same finger for repairing pulp defect. Methods From November 2003 to February 2005, 32 pulp defects in 30 cases were covered with neurovascular island flap from the same finger.There were 25 males and 5 females. The age ranged from 18 to 56 years. The operation was performedafter debridement and 2-8 days antibiotics therapy. The defect area ranged from 1.5 cm×1.2 cm to 3.5 cm×2.1 cm. The flap was harvested on the dorsal part ofthe finger ularly or radially. The distal end of the flap should be more than 5mm away from the nail base to avoid nail injury. The ventral and dorsal cut should not exceed the middle line respectively. The flap size ranged from 2.0 cm×1.5 cm to4.0 cm×2.5 cm. The donor site was covered with flap of subdermal vascular plexus from the medial side of the upper arm. Results All 32 transferred flaps survived after operation. There was no vascular crisis. Twentyfive cases were followed up from 2 to 8 months. The flaps had good appearance and texture and blood circulation. Two-point discrimination was 7-10 mm. The function of finger motion was returned to normal. Conclusion Transfer of neurovascular island flap from the same finger offered a sensational skin flap for reconstruction of pulp defect. The technique was simple, andthe clinical result was satisfactory. It is an ideal method for reconstruction of thumb or finger pulp defects.
ObjectiveTo explore the effectiveness of the side island flap coinciding dorsal branch of the digital nerve for repairing thumb pulp defects.
MethodsBetween May 2008 and July 2012,36 cases of thumb pulp defects were treated with the side island flap coinciding dorsal branch of the digital nerve.There were 26 males and 10 females,aged 21-51 years (mean,32.4 years).The injury causes included electric saw injury in 14 cases,punch press injury in 8 cases,machine twist injury in 5 cases,door crushing injury in 5 cases,and glass cutting injury in 4 cases.The left hand was involved in 12 cases and the right hand in 24 cases.Combined injuries included tendon and bone exposure in all cases,fracture of the distal phalanx in 3 cases,and nail bed lacerations in 2 cases.The defect size ranged from 1.4 cm×1.2 cm to 2.5 cm×2.1 cm;and the flap size ranged from 1.8 cm×1.4 cm to 3.0 cm×2.5 cm.
ResultsTwo flaps with distal skin flap tension blisters and skin scabbing,which were cured after dressing changes;the wound healed by first intension in the other 34 cases.The skin grafts at donor site survived,and primary healing of incision was obtained.The patients were followed up 3-15 months (mean,8 months).The appearance and function restored well.Two-point discrimination of the flap was 5.2 mm on average (range,4-8 mm) at last follow-up.The finger joint had no stiff.According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association,the sensation was S4 in 33 and S3+ in 3 cases.No ectopic feeling was observed.The extension and flexion activity of fingers at donor site was normal,the sensation reached S4 with no atrophy of the finger.
ConclusionWith constant anatomy,reliable blood supply,and safe operation,the anastomoses of the finger side island flap with dorsal branch of digital nerve is a better method to repair thumb pulp defects because it also effectively overcome the ectopic feeling with traditional methods and protect feel function of the fingers at donor site.
It is difficult to repair the pulp defect of finger with good function. Here reported two cases of pulp defect of the thumb which were repaired with free palmris brevis musculo-cutaneous flap. The flap was designed as the following: taken the line crossing the pisiform and metacarpo-phalangeal joint of the little finger as the longitudinal axis of the flap. The proximal end of the flap was at the level of pisiform and the distal end was the distal transverse palmar crease. The radial border was the radial side of the palmris brevis and ulnar border was the ulnar edge of the palm. The flap should not be larger than 6.5 cm x 2.5 cm. The flap was dissected with proper ulnar vessels and the accompanying arterial branch and superficial branch of the ulnar nerve. The flap was transferred to repair the pulp defect of the thumb. The vessels were anastomosed with the radial artery and cephalic vein at the snuffbox. The nerves were sutured to the digital nerve. Three months after operation, the defect was healed and the sensation of pulp was recovered. The donor area was painless and without sensation disturbance. The motion of the little finger was normal. The function of the thumb was restored. It was concluded that the palmaris brevis musculocutaneous flap is one of the best donor region to repair pulp defect of thumb.
