Regional first web flap used to cover the amputated stump of the thumb

The regional first web flap is a distally-based flap that is raised from the radiodorsal aspect of the metacarpophalangeal joint of the index finger towards the dorsal first web, and used to cover a thumb amputation. The advantage of this flap over the conventional cross-finger flap is that is gives a thicker and hairless flap with no skin graft to the donor site. Mobilisation of the joints, including the metacarpophalangeal joint of the index finger, can also be maintained during the immobilisation period between two stages.     

Use of an arterialised venous skin flap in the replantation of an amputated thumb

We report the replantation of an amputated thumb using a venous skin flap, harvested from the volar surface of the forearm, to make up the soft tissue defect, and to restore the vascular continuity to the thumb.     

Linguiform rotation flap for amputations of the fingertip

The aim of all treatments for fingertip amputation is to reconstruct the defects and meet the patient's needs. Sometimes an easy and versatile one-step procedure is needed. Between July 2005 and June 2006, 23 patients with amputated fingertips were treated with the linguiform rotation flap. It is a rotation advancement flap with the pedicle and a skin bridge usually on the volar side near the margin of the stump, and is based on one of the neurovascular bundles, the dorsal branches of the palmar digital arteries, the dorsal digital arteries, and the network among them. The follow-up period was 3 months to 1.5 years (mean 7.5 months), with relatively good results. The linguiform flap can be used for amputations at any level from the nailfold to the proximal interphalangeal joint to cover the exposed bone and tendon. The technique is simple and safe, and provides good protective padding. It is a good alternative for the reconstruction of fingertip amputations, particularly transverse, dorsal, and lateral oblique ones.     

应用改良的示指近节背侧皮瓣修复轻中度虎口挛缩

目的 介绍改良的示指近节背侧皮瓣在轻中度虎口挛缩治疗中的应用体会.方法 将原来的示指背侧岛状瓣或舌状瓣改成连同虎口一起的示指背侧局部转移皮瓣重建虎口,使皮瓣游离和虎口开大整体进行,简化了手术方法.结果 临床应用111例皮瓣全部成活,术后经3～18个月(平均8.5个月)的随访,局部外形美观,拇指功能恢复良好.虎口开大的优良率为94.6%.结论 改良的示指近节背侧皮瓣转位重建虎口是修复虎口挛缩的有效方法.     

拇指背侧皮神经营养血管蒂岛状皮瓣修复拇指指端缺损

目的探讨拇指背侧带皮神经营养血管蒂岛状皮瓣修复拇指指端缺损的临床效果。方法利用带拇指桡背侧或尺背侧皮神经营养血管蒂岛状皮瓣修复拇指指端软组织缺损12例。结果12例皮瓣全部成活,经6～24个月随访,拇指外形和功能恢复良好。结论拇指背侧皮神经营养血管蒂岛状皮瓣具有操作简单、成活率高、外形恢复满意等优点,是修复拇指指端缺损的理想方法。     

食指背岛状皮瓣修复拇指末节损伤

目的探讨用食指背侧岛状皮瓣转移修复拇指末节损伤的效果。方法采用同侧带血管或筋膜蒂食指背侧岛状皮瓣转移修复拇指末节软组织缺损12例。结果12例均得到随访,时间1年6个月～7年,皮瓣全部成活,修复后的拇指既保留了长度,又保存了感觉和运动功能,且外形满意。结论用食指背侧岛状皮瓣转移修复拇指末节损伤是一种有效安全的手术方法,技术难度不大,所需器械简单,具有临床实用价值。     

改良Moberg岛状推进皮瓣修复拇指指端皮肤缺损及长期疗效分析

目的介绍采用改良Moberg岛状推进皮瓣修复拇指指端皮肤缺损的适应证、疗效及长期随访结果。方法在解剖学研究的基础上对Moberg皮瓣进行改良,于1998年6月～2003年2月应用带神经血管蒂的改良Moberg岛状推进皮瓣修复各种水平的拇指指端皮肤缺损72例,并进行长期随访。结果皮瓣全部成活,指端缺损长度0.8～3cm。平均随访2年4个月,皮瓣在覆盖质量、感觉、耐寒程度及关节活动范围和捏力等方面疗效满意。结论采用改良Moberg皮瓣治疗拇指指端皮肤缺损相对于传统Moberg皮瓣适应证扩大,临床疗效满意,是治疗拇指指端皮肤缺损的有效方法之一。     

拇指桡背侧皮神经营养皮瓣修复拇指皮肤软组织缺损

目的探讨拇指背桡侧皮神经营养血管蒂的岛状皮瓣修复拇指软组织缺损的临床效果。方法对19例拇指软组织缺损患者利用拇指背桡侧皮神经营养血管皮瓣修复,其中修复感觉神经15例。缺损面积：1.5cm×1.0cm～2.5cm×2.5cm;皮瓣面积：2.0cm×1.5cm～3.0cm×2.5cm。结果19例皮瓣全部成活。随访5～30个月,皮瓣外观及感觉良好,指腹两点分辨觉为6～10mm。指间关节活动范围0°～80°。结论该皮神经皮瓣手术操作简单,皮瓣外形好,部分皮瓣能恢复感觉,是修复拇指软组织缺损的理想方法。     

改进的食指背侧岛状皮瓣修复拇指皮肤缺损

目的总结应用改进后的食指背侧岛状皮瓣在急诊中修复拇指创面的临床效果。方法改进筋膜血管蒂的切取方法，并将皮瓣内的桡神经浅支与拇指神经吻合。用此皮瓣在急诊中修复拇指软组织缺损6例。结果6例岛状皮瓣全部成活，术后随访2～24个月，效果均满意。结论应用改进后的食指背侧岛状皮瓣提高了皮瓣成活质量，且重建了拇指感觉功能，手术安全、简便，是一种比较理想的方法。     

The spiral flap for fingertip resurfacing: short-term and long-term results

PURPOSE: We describe a homodigital neurovascular island flap for reconstructing large pulp defects of the fingertips and review the short-term and long-term appearance and function of the reconstructed fingertips. METHODS: The spiral flap is a homodigital neurovascular island flap with a unique spiral advancement and transposition design that allows pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. Thirty-two fingertips were resurfaced using this flap. All had large pulp defects averaging 1.2 cm wide x 2.0 cm long (1.0-2.0 cm x 1.5-2.5 cm). Short-term results (<18 months) for all patients at a minimum of 6 months and long-term results (>5 years) for 10 patients with a mean follow-up of 13 years were reviewed. Objective outcome measures included static 2-point discrimination, degree of nail deformity (beaking), total active motion, and hypersensitivity or cold intolerance. Subjective outcome measures included patient satisfaction with function and aesthetics, using a visual analog scale. RESULTS: All flaps achieved primary healing with no complications. There was initially mild extension deficit in the proximal interphalangeal and distal interphalangeal joints, which improved to full range of motion in the long term. Sensory recovery was excellent, with an average 2-point discrimination of 5 mm initially, improving to 4 mm in the long term. Nail beaking was minimal initially but increased significantly in the long term. These results may be explained by soft tissue remodeling. All patients on long-term follow-up were highly satisfied with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance at either the short-term or long-term follow-up assessments. CONCLUSIONS: The spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term and long-term functional and aesthetic results and high patient satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

拇指桡侧指动脉关节皮支为蒂岛状皮瓣的临床应用

目的探讨以拇指桡侧指动脉关节皮支为蒂岛状皮瓣修复同指指腹缺损的临床效果。方法 2009年6月-2010年3月,收治10例10指拇指指腹缺损患者。男6例,女4例;年龄13～68岁,平均38岁。致伤原因:挤压伤4例,电刨伤3例,慢性感染2例,烫伤1例。末节指腹皮肤软组织缺损伴骨或肌腱外露4例,皮肤软组织缺损范围为1.0cm×0.8cm～2.0cm×1.4cm;近节指腹皮肤软组织缺损伴骨或肌腱外露6例,皮肤软组织缺损范围为1.0cm×0.8cm～2.5cm×2.0cm。病程3h～4个月。4例末节指腹缺损采用大小为1.0cm×0.8cm～2.2cm×1.5cm的拇指桡侧指动脉指间关节皮支为蒂岛状皮瓣修复;6例近节指腹缺损采用大小为1.0cm×0.8cm～2.6cm×2.2cm的拇指桡侧指动脉掌指关节皮支为蒂岛状皮瓣修复。供区游离植皮修复。结果术后皮瓣及植皮均顺利成活,创面Ⅰ期愈合。10例均获随访,随访时间6～12个月,平均8个月。皮瓣质地柔软,指腹外形无臃肿,颜色与患指周围皮肤相似。末次随访时皮瓣两点辨别觉为7～10mm。拇指功能根据总主动活动度(TAM)法评定,获优8例,良1例,可1例,优良率90%。结论拇指桡侧指动脉关节皮支为蒂岛状皮瓣不损伤拇指指动脉和指神经,手术操作简便,可较好修复拇指指腹缺损。     

(踇)甲瓣联合第二趾胫侧皮瓣修复拇指及虎口区皮肤缺损

目的 报道13例(踇)趾甲瓣联合第二趾胫侧皮瓣修复拇指及虎口皮肤缺损的临床效果.方法 2003～2007年间应用躅趾甲瓣联合第二趾胫侧皮瓣修复13例拇指及虎口皮肤缺损,其中2例为全手皮肤脱套伤.根据动脉的Gilbert分型采取不同的切取方式,2个组织瓣的神经应分别与受区相应神经吻合.结果 术后再造指及皮瓣全部成活,受区创面全部一期愈合.术后9例获得随访,平均随访时间7个月.再造指及皮瓣色泽与正常拇指相近.1年以上随访病例感觉恢复好,痛触温觉敏感,两点辨别觉为7～17 mm.拇指外展60°～85°,平均75°.拇指功能好,患者能恢复正常工作生活.结论 将拇指和虎口作为一个整体进行修复.应用(踇)趾甲瓣联合第二趾胫侧皮瓣修复拇指合并虎口区皮肤缺损是一种有效的修复方法,有利于手功能的恢复.     

Fenestrated Adipofascial Reverse Flap: A Modified Technique for the Reconstruction of Fingertip Amputations

Aims of the Study: Fingertip injuries can be treated in different ways, including shortening with primary closure, skin graft, and local or distant flaps. Several local flaps for the reconstruction of the amputated fingertip were described. We present our experience with a new concept of homodigital adipofascial reverse flap that avoids the second surgical stage and allows a complete and anatomically perfect reconstruction of nail bed, with preservation of the nail lamina. Materials and Methods: Between March 2014 and February 2015, five patients with digital amputations (distally to the nail matrix) were treated using the Fenestrated Adipofascial Reverse (F.A.R.) flap. The patients were evaluated measuring 2-point discrimination (2PD) value and range of motion of the distal interphalangeal joint (DIP). Scar evaluation was performed using the Vancouver Scar Scale (VSS). Results: All the flaps completely survived. A normal nail grow has been observed in first two-three months of post operatory follow-up. Length of the digits was preserved and good aesthetic as functional outcome were archive. The F.A.R. flap provided excellent coverage of fingertip defects and preserved finger length. After 1 year of follow, the mean static 2PD value at the reconstructed finger was 4.2 mm (range 3-5 mm), reconstructed fingers' mean range of motion for the DIP joint was 78 degrees and the VSS score ranged from 0 to 2 (mean score: 0.6). No complications were reported. Conclusions: F.A.R. flap is one of the most useful techniques in order to achieve all the goals in fingertip reconstruction.     

筋膜血管神经蒂食指背皮瓣急诊修复拇指缺损

目的：探讨筋膜血管神经蒂食指背皮瓣急诊修复拇指缺损的方法及疗效。方法：2010年10月～2012年6月，笔者单位应用筋膜血管神经蒂食指背皮瓣急诊修复拇指缺损患者共23例．男16例，女7例。年龄16～46岁，以中青年务工者居多。左侧10例．右侧13例，挤压毁损伤6例，撕脱伤8例，电锯伤9例：伤情均为拇指末节指骨或肌腱外露，皮肤软组织缺损。结果：术后除1例皮瓣远端血运不佳经换药创面愈合外，其余皮瓣全部成活，术后外形及功能良好，术后均有触、痛、温觉，患者均较满意。结论：筋膜血管神经蒂食指背皮瓣修复拇指缺损具有操作简单，手术一次完成，不需细小血管吻合技术，不需特殊设备，术后外形美观等优点。是年轻医生急诊处理拇指缺损的的理想方法。     

The reverse dorsal metacarpal flap from the first web

Summary Experience with the distally pedicled first dorsal metacarpal flap is presented. The anatomical basis of the flap is discussed, and four examples are presented from a group of ten cases. In this series, all flaps were successful. The possibility of using a second web reverse dorsal metacarpal flap and venous reverse flap of the dorsal part of the hand is also discussed.     

第一掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤脱套伤

【摘要】目的 探讨第1掌背动脉皮瓣联合大鱼际皮瓣修复拇指末节皮肤套脱伤的疗效。方法 2009年1月至2014年7月,我院对19例拇指末节皮肤套脱伤患者,创面缺损面积在20mm×50mm～30mm×60mm之间,拇指末节皮肤套脱合并甲床缺如13例,皮肤套脱伴甲床残留6例,均采用第1掌背动脉皮瓣联合大鱼际皮瓣进行修复,并观察术后19例拇指功能外形感觉等指标。 结果 本组12例皮瓣术后完全存活;5例术后2～4天皮瓣表面出现水疱,颜色暗红、发紫,间断拆除蒂部旋转点缝线后,皮瓣血运逐渐好转,最终存活良好;2例第1掌背动脉皮瓣尖端皮缘坏死,换药后痂下愈合,无骨外露,所有供区切口均1期愈合。经过3个月随访,手指皮瓣外形良好,指腹皮瓣感觉可,两点辨别觉6～9mm,指背皮瓣无感觉恢复;按照手指总主动活动度(TAM)法评定,优17指,良2指,优良率为100％,按照Michigan手外科问卷评定患者对拇指术后外观的满意度评定,非常满意15例,满意4例. 结论 该术式疗效满意,是治疗拇指末节皮肤套脱伤可行性的一种方法。