The surgical treatment of 20 cases (58 fingers) of swan-neek deformity of fingers after burns was reported. The operativc techniques included: (1) The cicatrix at the dorsal aspect of the finger was relcased and the raw surface thus formed was covered by skin graft, while the palmar skin was tightened; (2) Thc extensor mechanism of the finger was partially resected with relcase of the interosscous muscles and shortening of tcnodesis of the tendon of flexor digitorum superficialis; and (3) Fusion of the interphalangeal joint. The results of various methods of treatment were analyzed, and the pathogenesis of swan-neck deformity of fingers was discussed. The importance of prevention of its occurrence was emphasized.
The digital defects which severely interfered with the hand functions must be reconstructed. The primary repair by vascularized skin flap with the dorsal branch of proper palmar digital nerve could be done. The vascularized flap was rich in blood circulation, perfect sensibility and a good contour, as well as preserving donor digital sensation. However, it was simple, safe, and with higher success. From 1989 to 1991, 10 cases of digital defects were treated, all of the patients gained very good results. The indication and technique of thismethod wasdiscussed in detail.
Objective To investigate the benefit of the combined therapy for deformed fingers after burn injury by compairing with the conventionalone,and to sum up some experience. Methods From June 1999 to June 2004, 56 patients with deformed fingers entered the trial. In 28 patients of treatment group who received combined therapy(operation with postoperational systematic convalescent care, group A), there were 20 males and 8 females (14-47 years), 129 fingers of 47 hands were involved. In 28 of conventional group who received conventional therapy (the same operational principle, and self-convalescent-care with out-patient service guidance, group B), there were 17 males and 11 femals (18-51 years), 107 fingers of 42 hands were involved. Before and afterthe therapy, the finger’s motor function were assessed according to the Swansonmethod. The hand’s motor function was assessed through the Nine Hole Peg Test. Results The follow-up was 12-19 months in group A and 13-20 months in group B. The index of ankylosis (IA) of group A before therapy was82%±20%, and 45%±13% after theraphy; while the IA of group B before therapy was 78%±17%, and 52%±14% after therapy. The decreased of IA between before therapy and after therapy was 37%±15% in group A, and 26%±15% in group B, showing significant difference between the two groups (P＜0.05) . The Nine Hole Peg Test value of group A was 28.34±5.62s before therapy, and 20.73±4.25 s after therapy; while that of group B was 27.47±5.78 s before therapy, and 21.86±4.12 s after therapy. The decrease of the Nine Hole Peg Test value between before therapy and after therapy was 7.61±2.27 s in group A, and 561±294 s in group B, showing statistically significant difference (P＜0.05). Conclusion The combined therapy is more effective than the conventional one.
OBJECTIVE In order to solve the difficult problem of one-stage repair of degloving injury of multiple fingers, the common pedicled ilio-inguinal-hypogastric subdermal vascular network skin flap was designed and the multi-lobes skin flap was performed subsequently. METHODS From 1993 to 1996, there were 5 cases with degloving injuries of multiple fingers were treated by this flap. There were 2 males and 3 females and the age ranged from 7 to 19 years old. RESULTS After operation, the pedicles of the flap was detached between 12 to 16 days and all of the flaps survived completely. Patients were followed up for 6-18 months. After repair, the contour and skin colour of the digits were excellent, and the motion of the interphalangeal joints and skin sensation were good. CONCLUSION The conclusion was as follows: The newly designed skin flap was characterized by the advantages of duration of treatment being short, excellent contour and more rapid recovery of function. It could be used for one-stage repair of degloving injury of multiple fingers.
OBJECTIVE: To discuss the indication of replantation of destructive amputation of multiple fingers for improvement of the function of injured fingers. METHODS: From February 1996 to August 1999, 23 amputated fingers in 8 cases were shortened and replanted. The crushed digital bones were fixed by Kirschner wires, flexor tendons repaired by Kessler suture technique, and digital extensor tendons repaired by mattress suture. The arteries and veins were anastomosed in each finger at the ratio of 1 to 2 or 2 to 3. The defect of blood vessels was repaired by free graft of autologous veins in 5 fingers. All of the cases were followed up for 10 to 18 months, and clinical evaluation was performed. RESULTS: All replanted fingers survived in the 8 cases, with good sensation, two point discrimination of 6 to 12 mm, and satisfied function, such as pinching, grasping and hooking. The fingers were shortened for 2.6 cm in average, ranging from 2.2 cm to 4.0 cm. CONCLUSION: Multiple digits replantation by shortening fingers is beneficial to functional restoration of segmental destructive fingers.