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RECONSTRUCTION OF NAIL FOLDS BY DOUBLE PULP FLAP IN CONGENITAL COMPLETE SYNDACTYLY RELEASE

OBJECTIVE: To introduce a surgical approach for reconstruction of nail folds in congenital complete syndactyly release. METHODS: A narrow flap and a broad flap were raised on the common distal phalanx to cover the denuded nail-edge in 30 fingers of 15 cases whose webs were separated. RESULTS: All of the flaps were successfully transferred and survived. The reconstructed nail folds had satisfied figure in 21 out of 30 fingers. The nail folds in the other 9 fingers, covered by a broad flap in 2 fingers and by a narrow flap in 7 fingers, were a little smaller than normal. All of the 30 fingers had normal fullness of pulp and no twisty nails. CONCLUSION: The reconstruction of nail folds by double pulp flap can be performed with a one-stage technique, and the outcome is satisfactory, which make it as a good surgical approach to reconstruct nail folds in congenital complete syndactyly release.

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 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.

皮下包埋二期重建指腹治疗甲根部断指

目的 总结皮下包埋二期重建指腹治疗甲根部断指的疗效。 方法2009年8月－2011年6月，收治10例12指甲根部离断伤患者。男6例，女4例；年龄18～34岁，平均25岁。损伤指别：拇指1例，示指2例，中指5 例，环指3例，小指1例。断指按Ishikawa等分区标准均为Ⅱ区。末节掌侧缺损范围1.5 cm × 1.0 cm～2.5 cm × 2.0 cm。伤后至手术时间2～10 h，平均3.7 h。采用腹部皮下包埋回植的指骨及甲床，二期带神经的指动脉皮瓣重建指腹方法治疗，皮瓣切取范围1.8 cm × 1.2 cm～3.0 cm × 2.5 cm。 结果术后皮瓣均顺利成活。9例伤口Ⅰ期愈合；1例远端甲床部分坏死出现骨外露，行残端修整术后愈合。患者均获随访，随访时间6～24个月，平均12个月。患指长度与健侧接近，指甲生长平整，指腹饱满，质地柔软，弹性良好。皮瓣两点辨别觉6～9 mm，平均7.5 mm。术后复查X线片示回植指骨密度与健指接近，骨折愈合时间1～2.5个月，平均1.8个月，手指各关节活动正常。术后6个月手指功能按照中华医学会手外科学会上肢部分功能评定试用标准，获优5例，良4例，可1例。 结论应用皮下包埋回植指骨及甲床，二期重建指腹的方法修复断指，为无再植条件的甲根部离断伤提供了一种新的修复方法。

逆行指动脉皮瓣修复指腹缺损

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。

DECOMPRESSION AND DIVERTING EFFECTS OF VASCULAR ANASTOMOSIS BASED ON DIGITAL ARTERIAL ARCH BRANCH IN REPL ANTATION OF FREE FINGER-PULP

ObjectiveTo investigate the decompression and diverting effects of vascular anastomosis based on the digital arterial arch branch in replantation of free finger-pulp in distal phalanges. MethodsA retrospective analysis was performed on the clinical data of 12 patients (12 fingers) who underwent free finger-pulp replantation with anastomosis of proper palmar digital artery and the palmar digital artery arch branch in the distal end between December 2004 and March 2015. Of 12 cases, 9 were male and 3 were female, aged 15-39 years with an average of 32 years. The causes of injury included cutting injury in 4 cases, crush injury in 7 cases, and avulsion injury in 1 case. The thumb was involved in 2 cases, index finger in 4 cases, ring finger in 3 cases, middle finger in 1 case, and little finger in 2 cases. The free finger pulp ranged from 1.8 cm×1.5 cm to 2.8 cm×2.0 cm. The time from injury to operation ranged from 1.5 to 11.0 hours, with an average of 5.7 hours. No arterial arch or proper palmar digital arteriae anastomosis was excluded. ResultsFree finger-pulp survived in 11 cases after operation; venous crisis occurred in 1 case at 2 days after operation, and was cured after symptomatic treatment. Nine cases were followed up 6-18 months with an average of 10 months. The finger-pulp had good appearance, clear fingerprint, and soft texture. The two-point discrimination was 3.1-6.0 mm, with an average of 4.6 mm at 6 months after operation. The function of finger flexion and extension was normal. And according to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, the results were excellent in 7 cases, and good in 2 cases. ConclusionIn the replantation of amputated pulp with insufficiency of venous blood outflow, the anastomosis of digital arterial arch branch in the distal end can decompress and shunt arterial blood, adjust blood inflow and outflow, and solve the problems of insufficient quantity of the vein and venous reflux disturbance.

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。

大鱼际微型穿支皮瓣在拇指近节指腹挛缩修复中的应用

目的 总结大鱼际微型穿支皮瓣修复拇指近节指腹挛缩的方法及疗效。 方法2010年8月－2011年9月，收治拇指近节指腹挛缩患者9例。男6例，女3例；年龄17～60岁，平均45岁。致伤原因：再植术后挛缩 4例，机器绞伤3例，压砸伤2例。瘢痕挛缩3个月～2年。先行挛缩指腹开大，开大后指腹缺损范围为8 mm × 2 mm～30 mm × 15 mm；然后采用大小为25 mm × 10 mm～35 mm × 15 mm的大鱼际微型穿支皮瓣移位修复缺损。供区直接缝合。 结果术后皮瓣完全成活，创面Ⅰ期愈合；供区切口Ⅰ期愈合。患者均获随访，随访时间6～12个月，平均9个月。皮瓣外形良好，质地柔软。拇指背伸80～90°及外展90°。瘢痕无复发；大鱼际切口无瘢痕挛缩，拇指关节活动正常。末次随访时手功能按中华医学会手外科学会上肢部分功能评定试用标准评定，获优8指，良1指。 结论大鱼际微型穿支皮瓣具有不损伤主干动脉的优点，是修复拇指近节指腹挛缩的理想方法之一。