Repair of digital volar complex soft tissue defect with heterodigital antegrade digital artery island flap innervated by digital nerve_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Hui , HUO Yongxin , HAO Ruizheng , LIU Wei , CHANG Hong , LI Junran , WANG Bin

Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China;

Corresponding author：

WANG Hui, Email: wanghuiyxx@163.com

Keywords：

Digital volar defect; digital artery flap; nerve repair; wound repair

DOI：

10.7507/1002-1892.201903001

Video：

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Objective To investigate the effectiveness of heterodigital antegrade digital artery island flap innervated by proper digital nerve and the dorsal branch of proper digital nerve for repairing digital volar complex soft tissue defects. Methods Between May 2014 and January 2018, 27 patients with digital volar complex soft tissue defects were treated. There were 17 males and 10 females with an average age of 37 years (range, 18-60 years). The causes included electric saw injury in 8 cases, twisted injury in 12 cases, and heavy pound injury in 7 case. There were 9 thumbs, 5 index fingers, 6 middle fingers, 3 ring fingers, and 4 little fingers. The interval between injury and admission ranged from 1 to 4 hours (mean, 2.5 hours). The defect size ranged from 2.2 cm×1.4 cm to 3.8 cm×2.3 cm. The mean length of unilateral proper digital nerve defect was 2.9 cm (range, 2-4 cm). All defects were repaired with heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve. The proper digital nerve and the dorsal branch of the proper digital nerve in the flap were anastomosed with the proper digital nerve stumps in the wound. The flap size ranged from 2.4 cm×1.6 cm to 4.1 cm×2.6 cm. A segment of dorsal branch of the proper digital nerve was intercalated into the defect of the proper digital nerve in donor site. And the defect of donor site was repaired with the full-thickness skin graft. Results All flaps and skin grafts survived, and the wounds healed by first intention. All patients were followed up 12-24 months (mean, 17 months). The appearance, color, and texture of the flaps were similar to the surrounding tissue. There was no pain and double sensibility in any flap. At last follow-up, the static two-point discrimination of the flaps ranged from 4 to 8 mm (mean, 5.3 mm). And the two-point discrimination of digital pulps of recipient and donor fingers ranged from 4 to 10 mm with the average of 6.2 mm and 6.0 mm, respectively. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 18 cases and good in 9 cases. No scar contracture was observed in donor site. Conclusion The heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve provides a safe and simple technique with minimal donor site cost and satisfactory effectiveness, which could be an ideal option for repairing digital volar defect, especially for the defect complicated with digital nerve defect.

Citation： WANG Hui, HUO Yongxin, HAO Ruizheng, LIU Wei, CHANG Hong, LI Junran, WANG Bin. Repair of digital volar complex soft tissue defect with heterodigital antegrade digital artery island flap innervated by digital nerve. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1429-1432. doi: 10.7507/1002-1892.201903001 Copy

1.	Tang JB, Elliot D, Adani R, et al. Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg, 2014, 41(3): 325-359.
2.	Pham DT, Netscher DT. Vascularized heterodigital island flap for fingertip and dorsal finger reconstruction. J Hand Surg (Am), 2015, 40(12): 2458-2464.
3.	Chen C, Tang P, Zhang X. The dorsal homodigital island flap based on the dorsal branch of the digital artery: a review of 166 cases. Plastic Reconstr Surg, 2014, 133(4): 519e-529e.
4.	Shen H, Shen Z, Wang Y, et al. Extended reverse dorsal metacarpal artery flap for coverage of finger defects distal to the proximal interphalangeal joint. Ann Plast Surg, 2014, 72(5): 529-536.
5.	夏雷, 许玉本, 张红星, 等. 两种手部带蒂逆行皮瓣修复手指软组织缺损的疗效分析. 中华显微外科杂志, 2017, 40(2): 134-138.
6.	郑良军, 郭翱, 李俊, 等. 游离大鱼际部桡动脉掌浅支微型皮瓣移植修复手指掌侧缺损. 中华显微外科杂志, 2017, 40(5): 449-451.
7.	Seo BF, Kwon BY, Han HH. Sensate hypothenar perforator free flap for resurfacing large volar surface defect of the digit. Microsurgery, 2018, 38(4): 419-422.
8.	杨焕友, 李劲松, 王斌, 等. 指侧方岛状皮瓣修复邻指掌侧皮肤软组织缺损并重建血运及感觉. 中华烧伤杂志, 2018, 34(6): 389-391.
9.	黄良库, 许玉本, 李鹏, 等. 游离桡动脉掌浅支皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2018, 32(7): 955-958.
10.	晏桂明, 王小立, 刘宏国, 等. 踇趾腓侧游离皮瓣修复拇指和手指掌侧软组织缺损的临床经验. 中华显微外科杂志, 2018, 41(6): 589-591.
11.	陈靖, 陈情忠, 李双, 等. 改良动脉化静脉皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2019, 33(4): 475-478.
12.	赵民, 吴金英, 袁作雄, 等. 前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2019, 33(5): 586-589.
13.	Littler JW. The neurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg, 1953, 12(5): 303-319.
14.	Lee YH, Baek GH, Gong HS, et al. Innervated lateral middle phalangeal finger flap for a large pulp defect by bilateral neurorrhaphy. Plast Reconstr Surg, 2006, 118(5): 1185-1193.
15.	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.
16.	Adani R, Pancaldi G, Castagnetti C, et al. Neurovascular island flap by the disconnecting-reconnecting technique. J Hand Surg (Br), 1990, 15(1): 62-65.
17.	Wang H, Chen C, Li J, et al. Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects. J Hand Surg Eur Vol, 2016, 41(2): 177-184.

1. Tang JB, Elliot D, Adani R, et al. Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg, 2014, 41(3): 325-359.
2. Pham DT, Netscher DT. Vascularized heterodigital island flap for fingertip and dorsal finger reconstruction. J Hand Surg (Am), 2015, 40(12): 2458-2464.
3. Chen C, Tang P, Zhang X. The dorsal homodigital island flap based on the dorsal branch of the digital artery: a review of 166 cases. Plastic Reconstr Surg, 2014, 133(4): 519e-529e.
4. Shen H, Shen Z, Wang Y, et al. Extended reverse dorsal metacarpal artery flap for coverage of finger defects distal to the proximal interphalangeal joint. Ann Plast Surg, 2014, 72(5): 529-536.
5. 夏雷, 许玉本, 张红星, 等. 两种手部带蒂逆行皮瓣修复手指软组织缺损的疗效分析. 中华显微外科杂志, 2017, 40(2): 134-138.
6. 郑良军, 郭翱, 李俊, 等. 游离大鱼际部桡动脉掌浅支微型皮瓣移植修复手指掌侧缺损. 中华显微外科杂志, 2017, 40(5): 449-451.
7. Seo BF, Kwon BY, Han HH. Sensate hypothenar perforator free flap for resurfacing large volar surface defect of the digit. Microsurgery, 2018, 38(4): 419-422.
8. 杨焕友, 李劲松, 王斌, 等. 指侧方岛状皮瓣修复邻指掌侧皮肤软组织缺损并重建血运及感觉. 中华烧伤杂志, 2018, 34(6): 389-391.
9. 黄良库, 许玉本, 李鹏, 等. 游离桡动脉掌浅支皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2018, 32(7): 955-958.
10. 晏桂明, 王小立, 刘宏国, 等. 踇趾腓侧游离皮瓣修复拇指和手指掌侧软组织缺损的临床经验. 中华显微外科杂志, 2018, 41(6): 589-591.
11. 陈靖, 陈情忠, 李双, 等. 改良动脉化静脉皮瓣修复手指软组织缺损. 中国修复重建外科杂志, 2019, 33(4): 475-478.
12. 赵民, 吴金英, 袁作雄, 等. 前臂桡背侧穿支皮瓣游离移植修复手指皮肤缺损. 中国修复重建外科杂志, 2019, 33(5): 586-589.
13. Littler JW. The neurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg, 1953, 12(5): 303-319.
14. Lee YH, Baek GH, Gong HS, et al. Innervated lateral middle phalangeal finger flap for a large pulp defect by bilateral neurorrhaphy. Plast Reconstr Surg, 2006, 118(5): 1185-1193.
15. 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.
16. Adani R, Pancaldi G, Castagnetti C, et al. Neurovascular island flap by the disconnecting-reconnecting technique. J Hand Surg (Br), 1990, 15(1): 62-65.
17. Wang H, Chen C, Li J, et al. Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects. J Hand Surg Eur Vol, 2016, 41(2): 177-184.

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Chinese Journal of Reparative and Reconstructive Surgery

Repair of digital volar complex soft tissue defect with heterodigital antegrade digital artery island flap innervated by digital nerve

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