REPAIR OF COMPOSITE TISSUE DEFECTS OF DORSAL THUMB INCLUDING INTERPHALANGEAL JOINT BY TRANSPLANTATION OF MODIFIED HALLUX TOE-NAIL COMPOSITE TISSUE FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUJinwei , HEZaopeng ,  LIWei , ZHOUCongzhen , ZHENGYudong , ZENGDifan , LIUDongbo

Department of Hand and Foot Surgery, Affiliated Lecong Hospital of Guangzhou Medical University, Foshan Guangdong, 528315, P. R. China;

Corresponding author：

LIWei, Email: leclw@126.com

Keywords：

Hallux toe-nail composite tissue flap; Thumb; Composite tissue defect; Wound repair

DOI：

10.7507/1002-1892.20150303

Video：

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Objective To explore a new improved technique and its effectiveness to repair dorsal thumb composite tissue defects including interphalangeal joint by transplantation of modified hallux toe-nail composite tissue flap. Methods The hallux toe-nail composite tissue flap carrying distal half hallux proximal phalanx, extensor hallucis longus, and interphalangeal joint capsule were designed and applied to repair the dorsal skin, nails, and interphalangeal joint defect of thumb in 14 cases between January 2007 and June 2013. They were all males, aged from 19 to 52 years (mean, 30 years). The time from injury to hospital was 0.5-2.0 hours (mean, 1.2 hours). The area of the thumb nail and dorsal skin defects ranged from 2.5 cm×1.5 cm to 5.0 cm×2.5 cm. The dorsal interphalangeal joint had different degrees of bone defect, with residual bone and joint capsule at the palm side. The length of bone defect ranged from 2.5 to 4.0 cm (mean, 3.4 cm). The hallux nail flap size ranged from 3.0 cm×2.0 cm to 6.0 cm×3.0 cm. The donor sites were repaired by skin grafting in 5 cases, and retrograde second dorsal metatarsal artery island flap in 9 cases. Results After operation, arterial crisis occurred in 1 case and the flap survived after relieving pressure; the other flaps survived, and wounds healed by first intention. Liquefaction necrosis of the skin grafting at donor site occurred in 3 cases, and the other skin grafting and all retrograde second dorsal metatarsal artery island flaps survived. The follow-up ranged from 9 months to 3 years and 6 months (mean, 23 months). The secondary plastic operation was performed in 4 cases at 6 months after operation because of slightly bulky composite tissue flaps. The other composite tissue flaps had good appearance, color, and texture. The growth of the nail was good in 12 cases, and slightly thickened in 2 cases. At last follow-up, X-ray examination showed that bone graft and proximal phalanx of the thumb had good bone healing in 12 cases. Good bone healing was obtained at the donor site. According to the Hand Surgical Branch of Chinese Medical Association standard for thumb and finger reconstruction function, the results were excellent in 12 cases and good in 2 cases, and the excellent and good rate was 100%. No pain at donor site was observed, with normal gait. Conclusion Transplantation of modified hallux toe-nail composite tissue flap to repair dorsal thumb composite tissue defects including interphalangeal joint can effectively improve the appearance and function of the impaired thumb.

Citation： LIUJinwei, HEZaopeng, LIWei, ZHOUCongzhen, ZHENGYudong, ZENGDifan, LIUDongbo. REPAIR OF COMPOSITE TISSUE DEFECTS OF DORSAL THUMB INCLUDING INTERPHALANGEAL JOINT BY TRANSPLANTATION OF MODIFIED HALLUX TOE-NAIL COMPOSITE TISSUE FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1415-1418. doi: 10.7507/1002-1892.20150303 Copy

1.	陈启康, 李卫, 黄继辉, 等. 木工机械致手外伤的流行病学特点. 中华手外科杂志, 2003, 19(2):99-100.
2.	李卫, 刘金伟, 何藻鹏, 等. 拆分第二足趾修复两个相邻掌指关节背侧复合组织缺损. 中华显微外科杂志, 2012, 35(6):460-463.
3.	刘金伟, 何藻鹏, 李卫, 等. 改良第2跖趾关节移植修复拇手指掌指关节背侧缺损. 实用手外科杂志, 2014, 28(4):366-368, 465.
4.	李卫, 刘金伟, 何藻鹏, 等. 改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损. 中华手外科杂志, 2013, 29(3):167-169.
5.	王东, 凌彤, 谭成祥, 等. 第二跖背动脉逆行岛状皮瓣修复甲瓣切除后的创面. 中华手外科杂志, 2000, 16(1):40-42.
6.	蒋协远, 王大伟. 骨科临床疗效评价标准. 北京:人民卫生出版社, 2005:16-17.
7.	袁光海, 程国良, 方光荣, 等. 半趾甲瓣移植修复手指末节半侧缺损. 中华显微外科杂志, 2002, 25(3):168-169.
8.	李木卫, 陈飞, 马立峰, 等. 游离腓动脉穿支皮瓣修复足部供区创面的疗效. 中国修复重建外科杂志, 2014, 28(3):389-390.
9.	St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg (Am), 1997, 22(5):913-917.
10.	王欣, 章伟文, 陈宏, 等. 部分甲瓣移植修复拇指末节半侧缺损. 中华手外科杂志, 2006, 22(6):360-361.
11.	芮永军, 施海峰, 邱扬, 等. 不同构制的甲瓣修复手指套脱伤. 中华手外科杂志, 2007, 23(6):349-351.
12.	杨庆达, 张智钊, 卢家灵, 等. 改良第一趾蹼皮瓣游离移植术后供区创面的修复. 中国修复重建外科杂志, 2013, 27(10):1279-1280.
13.	Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg, 2005, 21(4):225-229.
14.	申立林, 蔺翠霞, 孙雪生, 等. 跗外侧动脉穿支皮瓣修复拇甲瓣供区创面的临床应用. 齐鲁医学杂志, 2015, 30(1):42-43.
15.	魏在荣, 孙广峰, 王达利, 等. 跖背动脉远端穿支蒂链型供血皮瓣修复足远端创面. 南方医科大学学报, 2010, 30(8):1835-1837.
16.	曲连军, 张成进, 刘学胜, 等. 用带远侧1/2末节趾骨的甲瓣修复拇指脱套伤. 中华显微外科杂志, 2007, 30(5):377-378.

1. 陈启康, 李卫, 黄继辉, 等. 木工机械致手外伤的流行病学特点. 中华手外科杂志, 2003, 19(2):99-100.
2. 李卫, 刘金伟, 何藻鹏, 等. 拆分第二足趾修复两个相邻掌指关节背侧复合组织缺损. 中华显微外科杂志, 2012, 35(6):460-463.
3. 刘金伟, 何藻鹏, 李卫, 等. 改良第2跖趾关节移植修复拇手指掌指关节背侧缺损. 实用手外科杂志, 2014, 28(4):366-368, 465.
4. 李卫, 刘金伟, 何藻鹏, 等. 改良第二跖趾关节移植修复木工机械致掌指关节背侧缺损. 中华手外科杂志, 2013, 29(3):167-169.
5. 王东, 凌彤, 谭成祥, 等. 第二跖背动脉逆行岛状皮瓣修复甲瓣切除后的创面. 中华手外科杂志, 2000, 16(1):40-42.
6. 蒋协远, 王大伟. 骨科临床疗效评价标准. 北京:人民卫生出版社, 2005:16-17.
7. 袁光海, 程国良, 方光荣, 等. 半趾甲瓣移植修复手指末节半侧缺损. 中华显微外科杂志, 2002, 25(3):168-169.
8. 李木卫, 陈飞, 马立峰, 等. 游离腓动脉穿支皮瓣修复足部供区创面的疗效. 中国修复重建外科杂志, 2014, 28(3):389-390.
9. St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg (Am), 1997, 22(5):913-917.
10. 王欣, 章伟文, 陈宏, 等. 部分甲瓣移植修复拇指末节半侧缺损. 中华手外科杂志, 2006, 22(6):360-361.
11. 芮永军, 施海峰, 邱扬, 等. 不同构制的甲瓣修复手指套脱伤. 中华手外科杂志, 2007, 23(6):349-351.
12. 杨庆达, 张智钊, 卢家灵, 等. 改良第一趾蹼皮瓣游离移植术后供区创面的修复. 中国修复重建外科杂志, 2013, 27(10):1279-1280.
13. Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg, 2005, 21(4):225-229.
14. 申立林, 蔺翠霞, 孙雪生, 等. 跗外侧动脉穿支皮瓣修复拇甲瓣供区创面的临床应用. 齐鲁医学杂志, 2015, 30(1):42-43.
15. 魏在荣, 孙广峰, 王达利, 等. 跖背动脉远端穿支蒂链型供血皮瓣修复足远端创面. 南方医科大学学报, 2010, 30(8):1835-1837.
16. 曲连军, 张成进, 刘学胜, 等. 用带远侧1/2末节趾骨的甲瓣修复拇指脱套伤. 中华显微外科杂志, 2007, 30(5):377-378.

Chinese Journal of Reparative and Reconstructive Surgery

REPAIR OF COMPOSITE TISSUE DEFECTS OF DORSAL THUMB INCLUDING INTERPHALANGEAL JOINT BY TRANSPLANTATION OF MODIFIED HALLUX TOE-NAIL COMPOSITE TISSUE FLAP

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