Objective To explore the effectiveness of the improved pedicled superficial iliac circumflex artery flap for repairing serious wound of the hand and forearm. Methods Between June 2008 and June 2011, 13 cases of serious wound of the hand and forearm were treated. There were 9 males and 4 females with a mean age of 41 years (range, 23-64 years). The disease causes included twist injury by machine in 2 cases, wire rope squeezed injury in 4 cases, traffic accident injury in 3 cases, crushing injury in 2 cases, high voltage electrical injury in 1 case, and snake bites in 1 case. There were 10 cases of fresh wounds and 3 cases of infection and necrosis wounds, and all had bone and tendon exposure. The skin and soft tissue defects ranged from 7 cm × 3 cm to 22 cm × 6 cm. The pedicled iliac artery flap was used in 8 cases, and pedicled iliac artery composite flap in 5 cases. The flap size ranged from 12 cm × 4 cm to 27 cm × 8 cm, with the flap pedicle of 2-4 cm wide strip and 3-5 cm wide fascia. Results The pedicle of flap was cut at 3 weeks in 12 patients, and at 4 weeks in 1 patient who had partial avulsion and hemorrhage at 1 week after operation. All flaps survived and incisions at donors and wounds healed by first intention. Eleven patients were followed up 6-36 months (mean, 20 months). The flap color and texture were good; 3 bulky flaps were observed, and satisfactory appearance was achieved after skin flap thinning. After 6 months, the protective sensation recovered in all cases; according to the Hand Surgery Society of Chinese Medical Association evaluation of upper extremity function trial standard for total active motion of the fingers, the results were excellent in 9 cases, good in 1 case, and poor in 1 case. Conclusion Improved fascia pedicled superficial iliac circumflex artery skin flap can repair serious hand and forearm injury, which is easy-to-operate and less injury at donor site.
ObjectiveTo evaluate the results of corticoplasty for multiple enchondromatosis of the hand. MethodsBetween February 2003 and January 2011, 6 patients with multiple enchondromatosis were treated. Of 6 cases, 1 was boy and 5 were girls with an average age of 10.8 years (range, 9-12 years); 5 cases presented with painless mass as first symptom, and 1 case was found to have mass by X-ray film because of hand injury. Physical examination at admission showed multiple mass on the hands, fingers deformity, and limited range of motion; X-ray film results showed large lesions in the phalanges and metacarpals. Corticoplasty and simple curettage without bone grafting were performed on 24 fingers (60 bones) with multiple enchondromatosis of the hand. The fingers active range of motion was used to evaluate the finger function; the diameter of the tumors was measured on the X-ray films; and according to Tordai's classification, tumor recurrence and new bone formation were observed. ResultsOnce, twice, or three-time operations were performed in 2 cases, respectively. All patients were followed up 17-83 months with an average of 52.2 months. At last follow-up, the active range of motion was significantly increased from (230.8±53.2)° at preoperation to (255.0±28.7)° at postoperation (t=—3.829, P=0.001); the tumor diameter was significantly decreased from (15.6±5.8) mm at preoperation to (10.7±3.7) mm at postoperation (t=8.304, P=0.000). Of 60 bones, 34 (56.7%) were rated as Tordai grade 1, and 26 (43.3%) as Tordai grade 2. During follow-up, clinical manifestation, characteristics of radiology and pathological examination showed no pathological fracture or malignant change. ConclusionCorticoplasty is a safe and effective treatment for multiple enchondromatosis of the hand in children. The procedure can improve appearance and motion function of the hand.
OBJECTIVE: To investigate the clinical effect of skin flaps repairing severe thermopressure injury of hand. METHODS: From January 1989 to December 1998, 112 patients with severe thermopressure injury of hand were repaired by various skin flaps transfer, the size of skin flaps was 6 cm x 8 cm to 12 cm x 18 cm. Postoperative patients were treated by combined rehabilitation in early stage. RESULTS: All the flaps were survived with satisfactory effect. Sixty-six patients were followed up 6 to 12 months, skin flaps all showed better colour and texture, and function of the hand was satisfactory. CONCLUSION: Different skin flaps are adopted to repair severe thermopressure injury of the hand according to different skin defects of the hand, combined early rehabilitation treatment, to achieve good recovery of function and appearance of the hand to the greatest extent.
OBJECTIVE: To explore a new surgical management of multiple fingers degloving injury. METHODS: In 1994 to 1997, 47 cases with multiple fingers degloving injury were sutured by two reverse "s"-type skin flaps on abdominal flank. RESULTS: The skin flaps in 46 cases survived and the wounds obtained primary heal. CONCLUSION: The application of abdominal flank "s"-type skin flap is reliable and convenient in the treatment of multiple fingers degloving injury.
ObjectiveTo investigate the effectiveness of dorsalis pedis flap series-parallel big toe nail composite tissue flap in the repairment of hand skin of degloving injury with tumb defect. MethodsBetween March 2009 and June 2013, 8 cases of hand degloving injury with thumb defect caused by machine twisting were treated. There were 7 males and 1 female with the mean age of 36 years (range, 26-48 years). Injury located at the left hand in 3 cases and at the right hand in 5 cases. The time from injury to hospitalization was 1.5-4.0 hours (mean, 2.5 hours). The defect area was 8 cm×6 cm to 15 cm×11 cm. The thumb defect was rated as degree I in 5 cases and as degree II in 3 cases. The contralateral dorsal skin flap (9 cm×7 cm to 10 cm×8 cm) combined with ipsilateral big toe nail composite tissue flap (2.5 cm×1.8 cm to 3.0 cm×2.0 cm) was used, including 3 parallel anastomosis flaps and 5 series anastomosis flaps. The donor site of the dorsal flap was repaired with thick skin grafts, the stumps wound was covered with tongue flap at the shank side of big toe. ResultsVascular crisis occurred in 1 big toe nail composite tissue flap, margin necrosis occurred in 2 dorsalis pedis flap;the other flaps survived, and primary healing of wound was obtained. The grafted skin at dorsal donor site all survived, skin of hallux toe stump had no necrosis. Eight cases were followed up 4-20 months (mean, 15.5 months). All flaps had soft texture and satisfactory appearance;the cutaneous sensory recovery time was 4-7 months (mean, 5 months). At 4 months after operation, the two-point discrimination of the thumb pulp was 8-10 mm (mean, 9 mm), and the two-point discrimination of dorsal skin flap was 7-9 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the results were excellent in 4 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. ConclusionDorsalis pedis flap series-parallel big toe nail composite tissue flap is an ideal way to repair hand skin defect, and reconstructs the thumb, which has many advantages, including simple surgical procedure, no limitation to recipient site, soft texture, satisfactory appearance and function of reconstructing thumb, and small donor foot loss.