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REPAIR OF PULP DEFECT OF THUMB BY FREE PALMARIS BREVIS MUSCULOCUTANEOUS FLAP

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.

REPAIR OF FINGER PULP DEFECT WITH TRANSVERSE DIGITAL PALMAR ISLAND FLAP

Objective To investigate the method and cl inical outcomes of repairing the skin and tissue defect of the finger pulp with transverse digital palmar island flap. Methods From August 2007 to September 2008, 9 patients with skin and tissue defects of the finger pulp were treated, including 6 males and 3 females aged 18-48 years old. The defect was caused bycrush injury by machine in 6 cases, pressure injury by heavy objects in 2 cases, and abrasion injury by grinding wheel in 1 case. The defect was located in the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 3 cases, the proximal phalanx in 1 case, the middle phalanx in 7 cases, and the distal phalanx in 1 case. The defect size ranged from 1.3 cm × 1.0 cm to 2.5 cm × 1.5 cm. The defect was compl icated with unilateral blood vessel and nerve defect in 8 cases, bone fracture in 2 cases, and tendon exposure in 5 cases. The time between injury and hospital admission was 20 minutes-14 hours. Transverse digital palmar island flaps (2.0 cm × 1.2 cm-4.0 cm × 1.7 cm) were used to repair the soft tissue defect during operation. The donor site was repaired with full-thickness skin graft. Results All the flaps and skin graft at the donor site survived uneventfully. All the wounds healed by first intention. Nine patients were followed up for 6-17 months. The appearance of the flaps was similar to that of the uninjured side, there was no occurrence of obvious pigmentation and scar contracture, and the two-point discrimination value was 8-11 mm. According to the function evaluation standard for the replantation of severed finger by Chinese Medical Association Hand Surgery Academy, 8 cases were graded as excellent, 1 as good. Conclusion Repairing the skin and tissue defects in the finger pulp of middle and distal phalanx with transverse digital palmar island flap can simpl ify the operation procedure, reduce the suffering of the patient, and provide satisfying therapeutic effect.

REPAIR OF THUMB PULP DEFECTS WITH SIDE ISLAND FLAP COINCIDING DORSAL BRANCH OF DIGITAL NERVE

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.

TRANSFER OF NEUROVASCULAR ISLAND FLAP FROM THE SAME FINGER FOR REPAIRING PULP DEFECT

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. Twentyfive 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.

同指指动脉顺行皮瓣修复末节指腹斜行缺损

REPAIR OF SOFT TISSUE DEFECT AT FINGER-TIPS BY CROSS-ARM SKIN FLAP WITH LATERAL ANTEBRANCHIAL CUTANEOUS NERVE

OBJECTIVE: To summarize the application of cross-arm skin flaps with lateral antebranchial cutaneous nerve in repair of soft tissue defect. METHODS: From March 1996 to March 2001, 37 cases of soft tissue defect at fingertips were repaired by cross-arm skin flaps with lateral antebranchial cutaneous nerve, 1.5 cm x 1.5 cm to 3.5 cm x 4.0 cm in size. All of the cases were followed up for 3-48 months with routine evaluation of the wound and the function of hands. RESULTS: All of the flaps survived and the wound achieved primary healing. The sensation and shape of hands recovered well. CONCLUSION: It’s a good choice to repair soft tissue defect at fingertips by cross-arm skin flaps with lateral antebranchial cutaneous nerve.

改良第一趾蹼皮瓣游离移植修复拇指指腹缺损

目的 总结吻合血管改良第1 趾蹼皮瓣游离移植修复拇指指腹缺损的疗效。 方法 2008 年2 月－2011 年2 月，收治拇指指腹缺损12 例。男8 例，女4 例；年龄20 ～ 57 岁，平均32.9 岁。机器绞伤7 例，电刨伤3 例，压砸伤2 例。新鲜创面10 例，受伤至入院时间为2 ～ 6 h；陈旧性创面2 例，均为拇指再植术后指腹坏死，于伤后13 d 及15 d 入院。创面范围3.0 cm × 2.0 cm ～ 3.6 cm × 2.8 cm，采用吻合血管改良第1 趾蹼皮瓣游离移植修复，切取的改良皮瓣保留了趾蹼原有功能结构，皮瓣切取范围3.4 cm × 2.3 cm ～ 4.4 cm × 3.0 cm；供区游离植皮或用穿支血管蒂足内侧隐神经营养血管皮瓣修复。 结果 术后供、受区皮瓣和植皮均完全成活，切口Ⅰ期愈合。术后患者均获随访，随访时间8 ～24 个月，平均10 个月。修复后拇指外形美观，伸屈、对掌功能正常，感觉恢复至S3 4 例，S3+ 6 例，S4 2 例。 结论 吻合血管改良第1 趾蹼皮瓣游离移植修复拇指指腹缺损，外形、功能恢复好，供区损伤小，是较好的修复方法之一。

中节带指背神经的逆行岛状筋膜皮瓣

目的 介绍中节带指背神经的逆行岛状筋膜皮瓣修复指腹皮肤缺损的方法。方法 2003年3月~2006年4月，应用带指背神经的逆行岛状筋膜皮瓣移位修复指腹皮肤缺损11例15指。其中男4例6指，女7例9指；年龄2～51岁。挤伤8例10指，切割伤3例5指。缺损范围1.5 cm×1.5 cm～2.0 cm×1.6 cm。（补充指别！）。切取皮瓣范围1.5 cm×1.5 cm～2.0 cm×1.6 cm。取前臂内侧全层皮片修复指背供区。结果 带指背神经的逆行筋膜岛状皮瓣皮均成活，受、供区创面均Ⅰ期愈合。术后获随访6~17个月，平均12个月。皮瓣色泽、质地与原指腹皮肤接近，指腹饱满。皮瓣两点辨别觉为4～5 mm。患指远、近侧指间关节无僵直、活动受限等。结论 采用带指背神经的逆行岛状筋膜皮瓣修复指腹皮肤缺损是一种简便、有效的手术方法。

指动脉逆行岛状皮瓣修复指腹缺损

Y-P形踇甲皮瓣修复手指指腹合并甲床缺损

目的总结 Y-P 形踇甲皮瓣修复手指指腹合并甲床缺损的疗效。方法2018 年 1 月—2019 年 8 月，收治 12 例（12 指）外伤致手指指腹合并甲床缺损患者。男 7 例，女 5 例；年龄 22～46 岁，平均 37 岁。拇指 2 例、示指 5 例、中指 3 例、环指 2 例。指腹缺损范围 1.5 cm×1.5 cm～2.0 cm×1.8 cm；甲床缺损均位于甲根以远，骨质及肌腱存留良好。受伤至入院时间 40 min～2 h，平均 1.5 h。术中切取携带趾腹皮瓣的 Y 形踇甲皮瓣并缝合为 P 形皮瓣后修复指腹及甲床缺损。供区创面直接拉拢缝合。结果术后踇甲皮瓣均顺利成活，创面均Ⅰ期愈合。供区切口均Ⅰ期愈合。患者均获随访，随访时间 6～18 个月，平均 12 个月。除 2 例指腹略臃肿外，其余患者指腹外形良好、质地佳；患者指腹均恢复部分指纹，指甲生长良好。末次随访时皮瓣两点辨别觉为 6～11 mm，平均 8 mm。供区切口无明显瘢痕且较隐蔽。结论Y-P 形踇甲皮瓣能充分利用足趾皮肤，有效增加皮瓣面积同时供区能直接缝合，是修复指腹及甲床缺损的较好方法。