Objective To discuss the clinical effect of cross-finger flap with cutaneous branch of the ulnar digital finger on repairing the palmar soft tissue defect of the finger. Methods From October 1996 to June 2004, crossfinger flaps were used to repair the palmar soft tissue defect of the finger in 25 cases( 32 fingers ) with tendon or bone exposed. There were 18 males and 7 females, and theirages ranged from 13 to 45 years. Among them, 6 cases were incised injury, 8 cases were impact and press injury, 11 cases were crush injury; and 2 cases were thumb, 8 cases were index, 5 cases were middle finger, 3 cases were ring finger, 2 cases were little finger, 2 cases were index and middle finger, 2 cases were middle and ring finger, and 1 cases were index, middle, ring and little finger. Thetime from injury to diagnosis was 30 min to 48 h, and the size of the tissue defect was 1.5 cm×1.0 cm to 4.1 cm×2.0 cm. All cases were treated with emergent operation, and the sense of the flap was recovered by anastomosing the cutaneous branch of the ulnar digital finger and the distal digital nerve of injured finger. The flap pedicle was dissected 3 weeks later. Results Followup was conducted for 6 to 26 months and it showed that the cross-finger flaps all survived with full digital fingertip, satisfactory appearance, good function, and normal sense. The discrimination of two points was 5-8 mm. Conclusion As it is easy to operate and with satisfactory appearance and good function restoration, cross-finger flap with cutaneous branch of the ulnar digital finger is effective in repairing the palmar soft tissue defect of the finger.
Objective To study the microsurgical anatomy of the facial nerve (FN ) trunk and provide some important morphometric data about facialhypoglossal nerve anastomosis (FHA). Methods Bilateral microsurgical dissection was performed on the heads of 9 cadarers fixed with formalinwith three different methods. In the first method, the posterior belly of the digastric muscle was used as a mark, and the FN trunk was identified on the medial side ofthis muscle. In the second method, dissection was initiated at the parotid gland, the FN trunk was identified at its entrance into the parotid gland. In the third method, the styloid process was identified and traced back to the stylomastoid foramen (SMF). The FN trunk was identified on its emergence from the SMF. In every dissection, the whole FN trunk was exposed; its diameter and depth at the the SMF and its length were measured; its relationship, with other structures was studied. Results The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.57±0.60mm. The mean minimal distance of the FN trunk from the skin surface in this area was 22.62±2.88 mm. The length of the FN trunk was 15.71±1.97 mm. The distance between the bifurcation and the mastoidale was 18.20±4.41 mm. The distance between the bifurcation and the mandibular angle was 39.91±8.38 mm. The distance between the mastoidale and the SMF was 17.91±2.68 mm. The branches fromthe FN trunk proximal to its bifurcation were the posterior auricular nerve, the digastric muscle nerve and the stylohyoid muscle nerve.Conclusion The third method to expose the FN trunk on its emergence from the SMFis safe and reliable. It is feasible to use only part of the hypoglossal nerve fibers for anastomosis with the FN trunk.
Objective To explore the changes of calcitonin gene-related peptide (CGRP) and substance P (SP) levels after end-toend and end-to-side neurorrhaphy. Methods Twenty female Wistar rats were divided into 4 experimental groups and control group. In the experimental groups, common peroneal nerves were transected on both sides. End-to-side coaptation was performed on the left, while end-to-end coaptation on the right. After 1, 2, 4 and 27 weeks, the rats were sacrificed, and immunoreactivities of CGRP and SP in suture sites, lumbar spine and dorsal root ganglia(DRGs) were evaluated respectively. Results The expression ofCGRP and SP decreased in dorsal horn and DRGs within 1 week postoperatively. After 4 -27 weeks, CGRP and SP in dorsal horn could return to almost normal level, but they had little recovery in DRGs. Although the trend of change between end-to-end and end-to-side was coincident, in most experimental groups, thereexisted differences in the dorsal horn between end-to-end and end-to-side. The sciatic nerve stained by acetylcholinesterase, SP, CGRP and PGP 9.5 showed that the fibers could pass through the suture site of either end-to-end or end-to-side. Conclusion Nerve regeneration can be achieved by end-to-side neurorrhaphy, andthe mechanism of sensory nerve recovery of these two methods is similar. But the recovery in end-to-side coaptation is insufficient to some degree.
OBJECTIVE: To summarize the application of cross-arm skin flaps with lateral antebranchial cutaneous nerve in repair of soft tissue defect. METHODS: From March 1996 to March 2001, 37 cases of soft tissue defect at fingertips were repaired by cross-arm skin flaps with lateral antebranchial cutaneous nerve, 1.5 cm x 1.5 cm to 3.5 cm x 4.0 cm in size. All of the cases were followed up for 3-48 months with routine evaluation of the wound and the function of hands. RESULTS: All of the flaps survived and the wound achieved primary healing. The sensation and shape of hands recovered well. CONCLUSION: It’s a good choice to repair soft tissue defect at fingertips by cross-arm skin flaps with lateral antebranchial cutaneous nerve.