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 discuss the method to repair the defects of palm with the improved flaps pedicled with the dorsal carpal branch of ulnar artery. METHODS: The improved flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery and the medial antebrechial cutaneous nerve, the ulnar artery was ligated and cut at the beginning of its dorsal carpal branch. The flap pedicled with dorsal carpal branch including the distal ulnar artery was achieved and applied clinically to repair 15 cases of the skin and soft tissue defects of palm from August 1997 to November 2001. The size of flaps ranged from 7 cm x 5 cm to 12 cm x 8 cm. RESULTS: All of the cases were followed up 3 weeks to 6 months, and the flaps completely survived. There was no ischemia and necrosis at the distal part of flaps and the appearance and function was satisfactory. CONCLUSION: The improved flap has long vascular pedicle, abundant blood supply and sensitive sensation, so it can be used to repair defect of palm.
OBJECTIVE: To provide anatomical bases for dorso-ulnar aspect of mid-hand reverse flap. METHODS: After red latex was infused into the arteries of 40 sides of adult cadava upper limbs, the origin, course, branches, distribution and distal anastomosis on the dorsal carpal branch of ulnar arteries were observed. And the mid-hand flap transfer was used to repair two cases of soft tissue defect (ranged 4.5-5.0 cm x 2.0-3.5 cm on ring and little fingers). RESULTS: The dorsal carpal branch begins with ulnar artery (3.9 +/- 1.2) cm above the pisiform with diameter of (1.3 +/- 0.2) mm, and branches off into ascending and descending branches. The descending one is the continuing of dorsal branch, it crosses the ulnar edge of the fifth metecarpal bone and anastomizes with the digital artery of little finger or hypothenar branch of deep palmar (accounted for 70%). While the other ascending branch with the former two branches formed anastomosis accounts for 30%. The two cases got healed in one-stage. The function of fingers recovered after 3-4 month follow-up. CONCLUSION: The reverse flap of dorso-ulnar aspect of mid-hand is available to repair the soft tissue defect on dorsum of hand with neighbor finger.