Objective To investigate the feasibility of temporary ectopic implantation of amputated fingers and dorsalis pedis flaps for thumb reconstruction and skin defect repair of the hand. Methods Between February 2006 and February 2012, 9 patients with thumb amputation having no replanted condition were treated. There were 7 males and 2 females with an average age of 35 years (range, 20-45 years). The injury causes included explosive injury in 1 case, puncher injury in 1 case, stiring machine injury in 1 case, gear injury in 3 cases, and heavy pound injury in 3 cases. At 2-5 hours after injury, one-stage temporary ectopic implantation of amputated finger to foot was performed. After debridement, thumb defect was rated as degree III in 1 case, as degree IV in 3 cases, and as degree V in 5 cases. When amputated fingers survived completely after 1-4 months, the amputated finger was replanted to its anatomic position, skin defect was repaired with dorsalis pedis flap. The area of skin defect ranged from 5 cm × 4 cm to 7 cm × 6 cm. The area of flaps ranged from 6 cm × 5 cm to 8 cm × 7 cm. The donor site was repaired by the skin grafting. Results Arterial crisis occurred in 1 case after 1 day of one-stage operation, and was cured after vascular exploration, and the amputated fingers survived in the others. The reconstructed thumbs and flaps survived after two-stage operation, and the skin graft at donor site survived. The patients were followed up 1-4 years (mean, 2.8 years). The reconstructed thumbs had good appearance and satisfactory opposition and finger-to-finger functions. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the scores of survival fingers were 73-91 (mean, 84); the results were excellent in 7 cases and good in 2 cases with an excellent and good rate of 100%. Conclusion Temporary ectopic implantation of amputated finger to foot combined with dorsalis pedis flap can be used to reconstruct thumb and repair skin defect of the hand.
Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf
Objective To investigate the cl inical effect and operative method of local island flap for complex thumb mutilation with soft tissue and blood vessel defect. Methods From May 2003 to March 2006, 6 cases of complex thumb mutilation with soft tissue and blood vessel defect were treated with local island flap. There were 4 males and 2 females aged 14-48 years, with an average of 23.5 years, among whom 2 cases were caused by triangular bandage twist, 3 cases by machinesavulsion and 1 case by explosion. Five cases suffered thumb mutilation of soft and blood vessel defect only, and 1 case was combined with middle and ring finger injures. The defect was located in pulp soft tissue in 4 cases and in dorsal soft tissue in 2 cases, ranging 2.0 cm × 1.2 cm-2.5 cm × 1.8 cm in size. The time from injury to operation varied from 30 minutes to 6 hours. Two cases were replanted with bridging index finger radial is digital artery island, 2 cases were repaired by ring finger radial is digital artery island and 2 cases by index finger near dorsi-flap. The flap was 2.0 cm × 1.4 cm-2.5 cm × 1.8 cm in size. Free-skin graft from forearm was conducted. Results All flaps free skin and replanted thumbs in 6 cases survived completely, following up for 6-24 months after operation. The flaps and thumb had good texture and color match, two-point discrimination was 10-12 mm on thumb pulp and 8-10 mm on flap. All replanted thumb recovered satisfied function, there were no donor site dysfunction. According to the criteria for function assessment of amputated finger issued by the Branch of Hand Surgery of Chinese Medicine Association：4 cases were regarded as excellent and 2 as good. Conclusion Local island flap is capable of repairing complex thumb mutilation with soft tissue and blood vessel defect, maximizing the recovery of thumb appearance and function.
OBJECTIVE: To explore a method to treat the mostly-isolated finger with its bilateral arteria injury without microsurgery. METHODS: To avoid exacerbating iatrogenically the wound, the methods of therapy mainly included the following procedures: debriding carefully, suturing the cutis and subcutaneous layer to fix internally the fracture without Kirschner wire, and not suturing the broken finger nerve or the broken tendon which had rebound. It was used in the emergency operation. After operation, heat therapy and Anisodamine were used to dilate capillary and micrangium of the unbroken soft tissue of the wounded finger, which was anatomically the only base of blood supply of pars of the wounded finger. RESULTS: In the 34 cases, main blood supply of the wounded finger was restored. The wound healed well in 28 cases. In 6 cases of necrosis in the edge of the wound, the necrosis were excised and the cicatricial healing was achieved. In 31 patients followed up, after the fracture had healed, the nerve and tendon were repaired. CONCLUSION: The methods above should be available for the mostly-isolated finger, especially in a hospital without microsurgery.