RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGBin ¹ , JIASong ¹ , LUAidong ² , HAORuizheng ¹ , HUOYongxin ¹ , FEIXiaoxuan ¹ , PANGHaitao ¹

1. Department of Hand Surgery, the Second Hospital of Tangshan (Affiliated Orthopedic Hospital of Hebei United University), Tangshan Hebei, 063000, P.R.China;
2. Department of Ophthalmology, Kailuan General Hospital;

Corresponding author：

WANGBin, Email: wbladyp3@163.com

Keywords：

Free second toe dorsal flap; Middle or ring finger island flap; Thumb; Degloving injury

DOI：

10.7507/1002-1892.20160284

Video：

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Objective To investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs. Methods Between August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years (mean, 32 years). The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts. Results All of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years (mean, 23 months). The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S₃, and the mean two-point discrimination of the pulp was 6 mm (range, 4-7 mm). According to total active movement (TAM) system, the function of the thumbs was excellent in 5 cases and good in 1 case. Conclusion A combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a degloved thumb.

Citation： WANGBin, JIASong, LUAidong, HAORuizheng, HUOYongxin, FEIXiaoxuan, PANGHaitao. RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1383-1386. doi: 10.7507/1002-1892.20160284 Copy

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2.	刘道功, 张浩, 简玉洛, 等.胸脐游离皮瓣在四肢软组织缺损修复中的应用.中华显微外科杂志, 2004, 27(4): 297-298.
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10.	焦伟, 王斌, 马铁鹏.指骨延长与关节成形修复再植手指短缩.中华手外科杂志, 2013, 29(6): 379-381.
11.	廖观祥.双侧姆趾皮瓣瓦合修复全拇指皮肤脱套伤的可行性研究.苏州:苏州大学, 2014.
12.	王斌.手部组织缺损的修复.北京:人民军医出版社, 2008: 241-254.
13.	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.
14.	王澍寰.手外科学. 3版.北京:人民卫生出版社, 2011: 486-487.
15.	廖观祥, 巨积辉, 刘新益, 等.双侧趾皮瓣瓦合修复拇指套脱伤可行性的初步探索.中国临床解剖学杂志, 2013, 31(6): 650-654.
16.	顾玉东.手的修复与再造.上海:上海医科大学出版社, 1995: 143.
17.	许亚军, 陈政, 姚群, 等.改良中环指岛状皮瓣加髂骨植骨再造拇指.实用手外科杂志, 2009, 23(2): 72-73.
18.	黄燮青, 章开衡, 沈华.甲皮瓣供区创面的处理.中国修复重建外科杂志, 2001, 15(6): 338-340.
19.	成红兵, 侍德, 张烽, 等.中环指双岛状皮瓣重建拇指的远期疗效.中华手外科杂志, 1997, 13(2): 96-99.

1. 郭旭, 董华祥, 石涛, 等.真皮下血管网皮瓣修复手指脱套伤38例.中国修复重建外科杂志, 2007, 21(1): 94-95.
2. 刘道功, 张浩, 简玉洛, 等.胸脐游离皮瓣在四肢软组织缺损修复中的应用.中华显微外科杂志, 2004, 27(4): 297-298.
3. 许亚军, 寿奎水, 芮永军, 等. 600例股前外侧皮瓣移植术的临床应用经验.中华整形外科杂志, 2005, 21(6): 418-420.
4. 王海文, 侯瑞兴, 冯连银, 等.带足背皮瓣的第二趾甲皮瓣修复全指皮肤脱套伤.中华手外科杂志, 2003, 19(4): 212.
5. Wang B, Zhang X, Jiang W, et al. Reconstruction of distally degloved fingers with a cross-finger flap and a composite-free flap from the dorsum of the second toe. J Hand Surg (Am), 2011, 37(2): 303-309.e1-4.
6. 芮永军, 施海峰, 邱扬, 等.部分甲瓣和第二趾腹皮瓣联合修复指脱套伤. 2005, 28(4): 295-296.
7. 王斌, 蒋文平, 李文龙, 等.游离第二足趾背甲皮瓣联合趾腓侧皮瓣游离移植修复单指脱套伤.中华显微外科杂志, 2012, 35(6): 444-446.
8. Adani R, Corain M, Tarallo L, et al. Alternative method for thumb reconstruction. Combination of 2 techniques: metacarpal lengthening and mini wraparound transfer. J Hand Surg (Am), 2013, 38(5): 1006-1011.
9. Ünal MB, Cansü E, Parmaksizoğlu F. Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg (Am), 2011, 36(4): 661-664.
10. 焦伟, 王斌, 马铁鹏.指骨延长与关节成形修复再植手指短缩.中华手外科杂志, 2013, 29(6): 379-381.
11. 廖观祥.双侧姆趾皮瓣瓦合修复全拇指皮肤脱套伤的可行性研究.苏州:苏州大学, 2014.
12. 王斌.手部组织缺损的修复.北京:人民军医出版社, 2008: 241-254.
13. 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.
14. 王澍寰.手外科学. 3版.北京:人民卫生出版社, 2011: 486-487.
15. 廖观祥, 巨积辉, 刘新益, 等.双侧趾皮瓣瓦合修复拇指套脱伤可行性的初步探索.中国临床解剖学杂志, 2013, 31(6): 650-654.
16. 顾玉东.手的修复与再造.上海:上海医科大学出版社, 1995: 143.
17. 许亚军, 陈政, 姚群, 等.改良中环指岛状皮瓣加髂骨植骨再造拇指.实用手外科杂志, 2009, 23(2): 72-73.
18. 黄燮青, 章开衡, 沈华.甲皮瓣供区创面的处理.中国修复重建外科杂志, 2001, 15(6): 338-340.
19. 成红兵, 侍德, 张烽, 等.中环指双岛状皮瓣重建拇指的远期疗效.中华手外科杂志, 1997, 13(2): 96-99.

Chinese Journal of Reparative and Reconstructive Surgery

RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP

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