REPAIR OF DEGLOVING INJURY OF FINGERTIP WITH VASCULAR PEDICLED CROSS FINGER FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Junyue , CUI Haojie , ZHANG Wei , LI Qichao , HE Kuile , PENG Yongli , BIAN Zhaohui.

Department of Hand Surgery, People’s Hospital of Renqiu, Renqiu Hebei, 062550, P.R.China. Corresponding author: CUI Haojie, E-mail: haojiecui@163.com;

Corresponding author：

Keywords：

Degloving injury of fingertip; Cross finger flap; Dorsal branch of proper digital artery; Wound repair

DOI：

10.7507/1002-1892.20130325

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Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm × 2.3 cm to 4.2 cm × 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.

Citation： LU Junyue,CUI Haojie,ZHANG Wei,LI Qichao,HE Kuile,PENG Yongli,BIAN Zhaohui.. REPAIR OF DEGLOVING INJURY OF FINGERTIP WITH VASCULAR PEDICLED CROSS FINGER FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(12): 1480-1483. doi: 10.7507/1002-1892.20130325 Copy

1.	14 李建宁, 巨积辉, 王强, 等. （足母）甲皮瓣与第二趾胫侧皮瓣瓦合修复拇指末节套脱伤. 中华手外科杂志, 2013, 29(1): 34-36.
2.	刘跃飞, 巨积辉, 侯瑞兴. 手指皮肤脱套伤治疗进展. 国际骨科学杂志, 2011, 32(3): 176-177.
3.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
4.	巨积辉, 刘跃飞, 侯瑞兴, 等. 手指套脱性断指再植. 中华手外科杂志, 2006, 22(6): 358-359．.
5.	Lin YH, Jeng CH, Hsieh CH, et al. Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton: a case report. Microsurgery, 2010, 30(6): 469-471.
6.	彭永利, 李启朝, 张双喜, 等. 腹部瓦合式皮瓣修复多指中末节套状撕脱伤. 中华手外科杂志, 2010, 26(3): 170-171.
7.	周晓, 许亚军, 芮永军, 等. 双蒂腹部真皮下血管网皮管修复2～5指双指脱套伤. 中国修复重建外科杂志, 2008, 22(11): 1402-1403.
8.	江起庭, 冯明生, 江志伟, 等. 同指两叶皮瓣瓦合修复手指远节脱套伤. 中国修复重建外科杂志, 2012, 26(7): 806-809.
9.	刘刚义, 席志峰, 王从虎, 等. 指动脉串联逆行岛状皮瓣修复指端脱套伤. 中国修复重建外科杂志, 2011, 25(9): 1030-1032.
10.	张文龙, 高顺红, 王斌, 等. 指动脉Y形分叶岛状皮瓣治疗手指末节脱套伤. 中华显微外科杂志, 2009, 32(5): 410-412.
11.	马铁鹏, 王斌, 尹佳丽, 等. 超半环形指动脉逆行岛状皮瓣修复手指末节离断型脱套伤. 中华显微外科杂志, 2008, 31(3): 202．.
12.	Tonkin MA. Pollicization for congenital thumb aplasia using the second dorsal metacarpal artery as the vascular pedicle: case report. J Hand Surg (Am), 2011, 36(3): 502-506.
13.	张文龙, 张子明, 高顺红, 等. 改良第二掌背动脉皮瓣修复示中指中末节套脱伤. 中华手外科杂志, 2011, 27(2): 87-89.
14.	张道坤, 张龙春, 陈莹. 第2、3掌背动脉双蒂逆行皮瓣修复中指中末节脱套伤. 临床骨科杂志, 2013, 16(1): 35-36.
15.	Chen C, Zhang X, Shao X, et al. Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap. J Hand Surg (Am), 2010, 35(10): 1663-1670.
16.	Doctor AM, Mathew J, Ellur S, et al. Three-flap cover for total hand degloving. J Plast Reconstr Aesthet Surg, 2010, 63(4): e402-405.
17.	巨积辉, 侯瑞兴, 李雷, 等. 第二趾甲皮瓣修复手指中末节皮肤脱套伤. 中华创伤杂志, 2008, 24(3): 220-221.
18.	Braga-Silva J, Kuyven CR, Fallopa F, et al. An anatomical study of the doasal cutaneous branches of the digital arteries. J Hand Surg (Br), 2002, 27(6): 577-579.
19.	Kim KS, Yoo SI, Kim DY, et al. Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery. Ann Plast Surg, 2001, 47(3): 263-268.
20.	邢丹谋, 周必光, 彭正人, 等. 指固有神经背侧支的应用解剖学研究. 中华手外科杂志, 2001, 17(1): 52-54．.
21.	李启朝, 张双喜, 陈振喜, 等. 指动脉中段背侧支岛状皮瓣的设计与应用. 中华整形外科杂志, 2011, 27(5): 340-344.

1. 14 李建宁, 巨积辉, 王强, 等. （足母）甲皮瓣与第二趾胫侧皮瓣瓦合修复拇指末节套脱伤. 中华手外科杂志, 2013, 29(1): 34-36.
2. 刘跃飞, 巨积辉, 侯瑞兴. 手指皮肤脱套伤治疗进展. 国际骨科学杂志, 2011, 32(3): 176-177.
3. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
4. 巨积辉, 刘跃飞, 侯瑞兴, 等. 手指套脱性断指再植. 中华手外科杂志, 2006, 22(6): 358-359．.
5. Lin YH, Jeng CH, Hsieh CH, et al. Salvage of the skin envelope in complex incomplete avulsion injury of thumb with venous arterializaiton: a case report. Microsurgery, 2010, 30(6): 469-471.
6. 彭永利, 李启朝, 张双喜, 等. 腹部瓦合式皮瓣修复多指中末节套状撕脱伤. 中华手外科杂志, 2010, 26(3): 170-171.
7. 周晓, 许亚军, 芮永军, 等. 双蒂腹部真皮下血管网皮管修复2～5指双指脱套伤. 中国修复重建外科杂志, 2008, 22(11): 1402-1403.
8. 江起庭, 冯明生, 江志伟, 等. 同指两叶皮瓣瓦合修复手指远节脱套伤. 中国修复重建外科杂志, 2012, 26(7): 806-809.
9. 刘刚义, 席志峰, 王从虎, 等. 指动脉串联逆行岛状皮瓣修复指端脱套伤. 中国修复重建外科杂志, 2011, 25(9): 1030-1032.
10. 张文龙, 高顺红, 王斌, 等. 指动脉Y形分叶岛状皮瓣治疗手指末节脱套伤. 中华显微外科杂志, 2009, 32(5): 410-412.
11. 马铁鹏, 王斌, 尹佳丽, 等. 超半环形指动脉逆行岛状皮瓣修复手指末节离断型脱套伤. 中华显微外科杂志, 2008, 31(3): 202．.
12. Tonkin MA. Pollicization for congenital thumb aplasia using the second dorsal metacarpal artery as the vascular pedicle: case report. J Hand Surg (Am), 2011, 36(3): 502-506.
13. 张文龙, 张子明, 高顺红, 等. 改良第二掌背动脉皮瓣修复示中指中末节套脱伤. 中华手外科杂志, 2011, 27(2): 87-89.
14. 张道坤, 张龙春, 陈莹. 第2、3掌背动脉双蒂逆行皮瓣修复中指中末节脱套伤. 临床骨科杂志, 2013, 16(1): 35-36.
15. Chen C, Zhang X, Shao X, et al. Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap. J Hand Surg (Am), 2010, 35(10): 1663-1670.
16. Doctor AM, Mathew J, Ellur S, et al. Three-flap cover for total hand degloving. J Plast Reconstr Aesthet Surg, 2010, 63(4): e402-405.
17. 巨积辉, 侯瑞兴, 李雷, 等. 第二趾甲皮瓣修复手指中末节皮肤脱套伤. 中华创伤杂志, 2008, 24(3): 220-221.
18. Braga-Silva J, Kuyven CR, Fallopa F, et al. An anatomical study of the doasal cutaneous branches of the digital arteries. J Hand Surg (Br), 2002, 27(6): 577-579.
19. Kim KS, Yoo SI, Kim DY, et al. Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery. Ann Plast Surg, 2001, 47(3): 263-268.
20. 邢丹谋, 周必光, 彭正人, 等. 指固有神经背侧支的应用解剖学研究. 中华手外科杂志, 2001, 17(1): 52-54．.
21. 李启朝, 张双喜, 陈振喜, 等. 指动脉中段背侧支岛状皮瓣的设计与应用. 中华整形外科杂志, 2011, 27(5): 340-344.

Chinese Journal of Reparative and Reconstructive Surgery

REPAIR OF DEGLOVING INJURY OF FINGERTIP WITH VASCULAR PEDICLED CROSS FINGER FLAP

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