Objective To investigate the effectiveness of cross finger flap pedicled with the dorsal branch of proper digital artery in repairing degloving injury of the fingertip. Methods Between January 2010 and June 2012, 13 cases of degloving injury of single fingertip were treated, including 9 males and 4 females with an average age of 33.6 years (range, 17-46 years). The defect locations were index finger in 5 cases, middle finger in 3 cases, ring finger in 3 cases, and little finger in 2 cases, including 4 cases of mechanical injury, 6 cases of twist injury, and 3 cases of crushing injury. The extent of skin avulsion was beyond the distal interphalangeal joint. The length of the avulsion was 1.0-2.1 cm (mean, 1.8 cm). Complicated injuries included phalangeal fracture in 2 cases. The time from injury to operation was 90-330 minutes (mean, 150 minutes). The wound was repaired with the cross finger flap pedicled with the dorsal branch of proper digital artery. The size of flaps ranged from 3.2 cm × 2.3 cm to 4.2 cm × 3.1 cm. After 3-4 weeks, the pedicle was cut. The donors were closed by skin graft. Results Tension blisters of the flap and partial necrosis of skin graft occurred in 3 cases and in 1 case respectively, which were cured after symptomatic treatment; the flap and skin graft survived, and primary healing was obtained in the other cases. Thirteen patients were followed up 6-10 months (mean, 7 months). The texture and appearance of all the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 7 to 10 mm (mean, 8.1 mm). The total active movement of the fingers were excellent in 10 cases and good in 3 cases, and the excellent and good rate was 100%. Conclusion The treatment of degloving injury of fingertip with the cross finger flap pedicled with the dorsal branch of proper digital artery is recommendable for the advantages of reliable blood supply, simple operation, high survival rate of the flap, good function recovery of the finger, and satisfactory appearance.
Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
Objective To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled. Methods Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years(mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13cases, middle finger in 11 cases, ring finger in 9 cases, and l ittle finger in 7 cases. The defect area ranged from 3.0 cm × 2.0 cm to 5.5 cm × 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arteril ization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm × 1.5 cm to 2.6 cm × 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm × 2.0 cm to 3.5 cm × 2.5 cm. The donor sites were covered with free flaps. Results Flap bl ister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and goodrate was 96.7%. Conclusion The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easyto- operate with less injury.
Objective To evaluate the cl inical efficacy of akin united flaps pedicled with dorsal carpal branch of ulnar artery in repairing compl icated degloving injuries of the opposite fingers. Methods Between August 2005 and August 2009, 11 cases of compl icated degloving injuries of single finger were treated, including 8 males and 3 females with an average age of 26 years (range, 19-55 years). The defect locations were thumb in 1 case, index finger in 7 cases, and middle finger in 3 cases, including 9 cases of mechanical injury and 2 cases of traffic accident injury. The extent of skin avulsion was the proximal segments or beyond the middle segment of finger with a defect range from 5.0 cm × 4.5 cm to 8.0 cm × 5.5 cm. Compl icated injuries included phalangeal fracture in 2 cases, extensor tendon injury in 3 cases, flexor and extensor tendon injuries in 1 case, digital vascular injury in 9 cases, and digital nerve injury in 6 cases. The time from injury to operation was 2-18 hours (mean, 4.8 hours). The akin united flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery. The proximally pedicled flaps enclosed palmar finger, and the distally pedicled flaps enclosed dorsal finger. The size of flaps ranged from 10 cm × 3 cm to 16 cm × 3 cm. The donor sites were sutured directly. After 3 weeks, the pedicle was cut. Results Light yellow secretion and eczema on the flap were observed in 1 case at 3 days, were cured after 2 weeks of dressing change; other flaps survived and healing of incisions by first intention was achieved. The incisions at donor sites healed by first intention. The secondary plastic operation was performed in 2 cases because of bulky flaps at 3 months after operation. Eleven patients were followed up postoperatively 6-12 months (8 months on average). The texture and appearance of all the flaps were satisfactory. The two-point discrimination was 12-20 mm with satisfactory recovery of finger function at 6 months after operation. According to Jebsen standard, the results were excellent in 8 cases, good in 2 cases, and poor in 1 case. Conclusion With rel iable blood supply, easy dissection, less injury at donor site, and good repair results, the akin united flaps pedicled with dorsal carpal branch ofulnar artery is a good method to repair complicated degloving injuries of the opposite fingers.
Objective To investigate the effectiveness of reverse island flaps of digital artery parallel for repairing degloved injuries of the fingerti p. Methods Between June 2008 and January 2010, 13 cases of degloved injuries of the fingertip were treated. There were 8 males and 5 females with an average age of 34 years (range, 19-62 years). The causes of injuries were as follow: impact and press injury in 5 cases, wringer injury in 7 cases, and crush injury in 1 case. The injured fingers were comprised of index finger in 6 cases, middle finger in 4 cases, ring finger in 2 cases, and l ittle finger in 1 case. The size of skin and soft tissue defect ranged from 2.0 cm × 1.8 cm to 3.0 cm × 2.5 cm. Three cases compl icated by fracture of thedistal phalanx, 1 case by rupture of the insertion of extensor tendon, and 1 case by rupture of the insertion of flexor tendon. The average time from injure to surgery was 4 hours (range, 1 hour and 30 minutes-12 hours). Two neighboring skin flaps located in the same course of digital artery were adopted to repair defect of the fingertip. The size of proximal skin flap ranged from 1.2 cm × 1.0 cm to 2.0 cm × 1.5 cm and the size of distal skin flap ranged from 1.1 cm × 1.0 cm to 1.5 cm × 1.3 cm. The free skin grafts were used to repair the donor sites. Results Circulation crisis occurred in 1 case at 2 hours after operation and was el iminated by interval disconnecting. The other flaps and skin grafts survived and the wounds healed by first intention. The patients were followed up 6-18 months (mean, 10 months). All flaps presented the satisfactory appearance and texture, and the flexion and extension function of wounded fingers recovered to normal. Two-point discrimination ranged from 7 to 11 mm at last follow-up. According to the functional assessment criteria of upper l imb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%. Conclusion Based on the anatomical features of communicating branches of distal interphalangeal joint, two neighboring flaps located in the same course of digital artery are adopted to repair soft tissue defect of the fingertip. This surgical method is a simple and effective method.