Application of wrap-around great toe flap combined with medial plantar artery perforator flap for completely degloved fingers_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lin , ZHOU Xin , HUANG Yu , HUANG Bo , LIU Anming , CHEN Xiaojun ,  ZOU Yonggen

Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding author：

ZOU Yonggen, Email: Yonggenzou1975@163.com

Keywords：

Wrap-around great toe flap; medial plantar artery perforator flap; finger; degloved injury

DOI：

10.7507/1002-1892.202111019

Video：

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Objective To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Methods Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. Results All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S₃-S₄. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.

Citation： TANG Lin, ZHOU Xin, HUANG Yu, HUANG Bo, LIU Anming, CHEN Xiaojun, ZOU Yonggen. Application of wrap-around great toe flap combined with medial plantar artery perforator flap for completely degloved fingers. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(4): 456-460. doi: 10.7507/1002-1892.202111019 Copy

1.	Nazerani S, Motamedi MH, Nazerani T, et al. Treatment of traumatic degloving injuries of the fingers and hand: introducing the “compartmented abdominal flap”. Tech Hand Up Extrem Surg, 2011, 15(3): 151-155.
2.	Del Piñal F. Extreme thumb losses: reconstructive strategies. Plast Reconstr Surg, 2019, 144(3): 665-677.
3.	Sun W, Chen C, Wang Z, et al. Full-length finger reconstruction for proximal amputation with expanded wraparound great toe flap and vascularized second toe joint. Ann Plast Surg, 2016, 77(5): 539-546.
4.	Wang Z, Sun W, Lineaweaver WC, et al. Distal finger reconstruction by bilateral lateral hallux osteo-onychocutaneous free flap. Ann Plast Surg, 2019, 82(3 Suppl 2): S157-S161.
5.	Shen XF, Mi JY, Xue MY, et al. Modified great toe wraparound flap with preservation of plantar triangular flap for reconstruction of degloving injuries of the thumb and fingers: long-term follow-up. Plast Reconstr Surg, 2016, 138(1): 155-163.
6.	Jyoshid RB, Vardhan H, Anto F. Free medial plantar artery flap for the reconstruction of great toe pulp. J Plast Reconstr Aesthet Surg, 2014, 67(6): 863-865.
7.	Rui Y, Mi J, Shi H, et al. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers. Microsurgery, 2010, 30(6): 449-456.
8.	Chi Z, Yang P, Song D, et al. Reconstruction of totally degloved fingers: a novel application of the bilobed spiraled innervated radial artery superficial palmar branch perforator flap design provides for primary donor-site closure. Surg Radiol Anat, 2017, 39(5): 547-557.
9.	郑大伟, 黎章灿, 许立, 等. 尺动脉腕上皮支双叶皮瓣修复手指脱套伤. 中华显微外科杂志, 2013, 36(4): 388-390.
10.	Zhang JF, Wang L, Hao RZ, et al. Treatment of fingertip avulsion injuries using two periposition pedicled flaps. J Plast Reconstr Aesthet Surg, 2019, 72(4): 628-635.
11.	Chi Z, Gao W, Yan H, et al. Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap. J Hand Surg (Am), 2012, 37(5): 1042-1050.
12.	Yan H, Fan C, Gao W, et al. Finger pulp reconstruction with free flaps from the upper extremity. Microsurgery, 2012, 32(5): 406-414.
13.	Zhang G, Ju J, Zhao Q, et al. Combined ipsilateral and contralateral second toe flaps for repair of finger degloving injury. Microsurgery, 2014, 34(7): 540-546.
14.	王增涛. 拇指及手指的全形再造. 中华显微外科杂志, 2020, 43(5): 424-434.
15.	黄钰, 巨积辉, 侯瑞兴, 等. 游离旋髂浅动脉穿支皮瓣修复多手指皮肤脱套伤. 中国美容整形外科杂志, 2020, 31(3): 157-160.
16.	周健辉, 周丽杏, 冷树立, 等. 踇甲皮瓣联合足底内侧皮瓣再造Ⅱ和Ⅲ度缺损手指. 中华显微外科杂志, 2018, 41(5): 492-494.
17.	孙文海. 长手指组合再造的应用解剖和数字化模型研究. 广州: 南方医科大学, 2016.
18.	许靖. 数字化设计结合3D打印在拇手指全形再造中的应用及相关解剖. 广州: 南方医科大学, 2019.
19.	Guillier D, Cherubino M, Oranges CM, et al. Systematic reappraisal of the reverse-flow medial plantar flap: From vascular anatomical concepts to surgical applications. J Plast Reconstr Aesthet Surg, 2020, 73(3): 421-433.
20.	Lohasammakul S, Turbpaiboon C, Chaiyasate K, et al. Anatomy of medial plantar superficial branch artery perforators: Facilitation of medial plantar superficial branch artery perforator (MPAP) flap harvesting and design for finger pulp reconstruction. Microsurgery, 2018, 38(5): 536-543.

1. Nazerani S, Motamedi MH, Nazerani T, et al. Treatment of traumatic degloving injuries of the fingers and hand: introducing the “compartmented abdominal flap”. Tech Hand Up Extrem Surg, 2011, 15(3): 151-155.
2. Del Piñal F. Extreme thumb losses: reconstructive strategies. Plast Reconstr Surg, 2019, 144(3): 665-677.
3. Sun W, Chen C, Wang Z, et al. Full-length finger reconstruction for proximal amputation with expanded wraparound great toe flap and vascularized second toe joint. Ann Plast Surg, 2016, 77(5): 539-546.
4. Wang Z, Sun W, Lineaweaver WC, et al. Distal finger reconstruction by bilateral lateral hallux osteo-onychocutaneous free flap. Ann Plast Surg, 2019, 82(3 Suppl 2): S157-S161.
5. Shen XF, Mi JY, Xue MY, et al. Modified great toe wraparound flap with preservation of plantar triangular flap for reconstruction of degloving injuries of the thumb and fingers: long-term follow-up. Plast Reconstr Surg, 2016, 138(1): 155-163.
6. Jyoshid RB, Vardhan H, Anto F. Free medial plantar artery flap for the reconstruction of great toe pulp. J Plast Reconstr Aesthet Surg, 2014, 67(6): 863-865.
7. Rui Y, Mi J, Shi H, et al. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers. Microsurgery, 2010, 30(6): 449-456.
8. Chi Z, Yang P, Song D, et al. Reconstruction of totally degloved fingers: a novel application of the bilobed spiraled innervated radial artery superficial palmar branch perforator flap design provides for primary donor-site closure. Surg Radiol Anat, 2017, 39(5): 547-557.
9. 郑大伟, 黎章灿, 许立, 等. 尺动脉腕上皮支双叶皮瓣修复手指脱套伤. 中华显微外科杂志, 2013, 36(4): 388-390.
10. Zhang JF, Wang L, Hao RZ, et al. Treatment of fingertip avulsion injuries using two periposition pedicled flaps. J Plast Reconstr Aesthet Surg, 2019, 72(4): 628-635.
11. Chi Z, Gao W, Yan H, et al. Reconstruction of totally degloved fingers with a spiraled parallelogram medial arm free flap. J Hand Surg (Am), 2012, 37(5): 1042-1050.
12. Yan H, Fan C, Gao W, et al. Finger pulp reconstruction with free flaps from the upper extremity. Microsurgery, 2012, 32(5): 406-414.
13. Zhang G, Ju J, Zhao Q, et al. Combined ipsilateral and contralateral second toe flaps for repair of finger degloving injury. Microsurgery, 2014, 34(7): 540-546.
14. 王增涛. 拇指及手指的全形再造. 中华显微外科杂志, 2020, 43(5): 424-434.
15. 黄钰, 巨积辉, 侯瑞兴, 等. 游离旋髂浅动脉穿支皮瓣修复多手指皮肤脱套伤. 中国美容整形外科杂志, 2020, 31(3): 157-160.
16. 周健辉, 周丽杏, 冷树立, 等. 踇甲皮瓣联合足底内侧皮瓣再造Ⅱ和Ⅲ度缺损手指. 中华显微外科杂志, 2018, 41(5): 492-494.
17. 孙文海. 长手指组合再造的应用解剖和数字化模型研究. 广州: 南方医科大学, 2016.
18. 许靖. 数字化设计结合3D打印在拇手指全形再造中的应用及相关解剖. 广州: 南方医科大学, 2019.
19. Guillier D, Cherubino M, Oranges CM, et al. Systematic reappraisal of the reverse-flow medial plantar flap: From vascular anatomical concepts to surgical applications. J Plast Reconstr Aesthet Surg, 2020, 73(3): 421-433.
20. Lohasammakul S, Turbpaiboon C, Chaiyasate K, et al. Anatomy of medial plantar superficial branch artery perforators: Facilitation of medial plantar superficial branch artery perforator (MPAP) flap harvesting and design for finger pulp reconstruction. Microsurgery, 2018, 38(5): 536-543.

Chinese Journal of Reparative and Reconstructive Surgery

Application of wrap-around great toe flap combined with medial plantar artery perforator flap for completely degloved fingers

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