Objective To investigate the operative techniques and cl inical results of the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery in repairing donor site defect of forefoot. Methods From March 2005 to October 2007, 15 patients (11 males and 4 females, aged 20-45 years with an average of 33.6 years) with finger defects resulting from either machine crush (12 cases) or car accidents (3 cases) were treated, including 12 cases of thumb defect, 2 of II-V finger defect and 1 of all fingers defect. Among them, 6 cases were reconstructed with immediate toe-to-hand free transplantation after injury, and 9 cases were reconstructed at 3-5 months after injury. The donor site soft tissue defects of forefoot were 6 cm × 4 cm-12 cm × 6 cm in size, and the superficial peroneal neruofasciocutaneousflaps ranging from 10 cm × 4 cm to 14 cm × 6 cm were adopted to repair the donor site defects after taking the escending branch of the distal perforating branch of peroneal artery as flap rotation axis. The donor sites in all cases were covered with intermediate spl it thickness skin grafts. Results All flaps survived and all wounds healed by first intention. All reconstructed fingers survived completely except one index finger, which suffered from necrosis. Over the 6-18 months follow-up period (mean 11 months), the texture and appearance of all the flaps were good, with two-point discriminations ranging from 10-13 mm, and all patients had satisfactory recovery of foot function. No obvious discomfort and neuroma were observed in the skin-graft donor sites. The feel ing of all the reconstructed fingers recovered to a certain degree, so did the grabbing function. Conclusion Due to its rel iable blood supply, no sacrifice of vascular trunks, favorable texture and thickness and simple operative procedure, the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery is effective to repair the donor site defect in forefoot caused by finger reconstruction with free toe-to-hand transplantation.
Objective To discuss the surgical method and effect of repair of damage injury in the hands. Methods Of the 29 cases, 22 were males, 7 were females. Their ages ranged from 15 to 31.The size of defect areas ranged from 18 cm×8 cm to 22 cm×10 cm .Along with dorsalis pedis flap, lateral hemi-pulp flap was takenfrom great toe and first web space flap. The second toe was taken from one footto reconstruct the thumb, second and third toe from another foot was used to reconstruct two fingers. The dorsalis pedis flaps were used to cover palm and dorsum of hand. The lateral hemi-pulp flaps from great toe and first web space flapswere used to reconstruct first web space of hand.Results With the 58 combined flaps, 29 thumbs and 58 fingers were reconstructed. Followups was done for 1 to 8 years.All the thumbsand fingers of 29 hands were reconstructed. Their shape and function were well recovered. Conclusion This new surgical method is effective inpreserving the function of injured hand. The function of the injured hands can be preserved by this surgical method, therefore this method is optimal.