指掌横支血管蒂指掌侧皮瓣修复指端缺损

目的 探讨一种新的对指端组织缺损的皮瓣修复方法.方法 以指动脉的掌横支为血管蒂,设计指掌侧皮瓣,逆行转移覆盖指端缺损创面.结果 临床应用11例12指,1指皮瓣坏死,11指皮瓣全部成活,外形满意.结论 这是一种新的、对指端提供了良好的指脂垫和感觉功能的手术方法且操作简单.     

Innervated reverse island flap based on the end dorsal branch of the digital artery: surgical technique

Fingertip or pulp loss of the fingers is observed frequently in unskilled workers. To reconstruct a sensate fingertip or pulp we designed the innervated reverse island flap based on the end dorsal branch of the digital artery, which was harvested from the dorsum of the middle phalanx. The sensation of the fingertip or pulp was re-established through coaptation of the proper branches of the digital dorsal nerves to the digital nerves. Three fingertip or pulp defects were reconstructed with this technique. All patients achieved satisfactory functional and cosmetic results. The mean follow-up time was 7.7 months. The average size of the flaps was 1.6 x 1.8 cm. The average static 2-point discrimination and moving 2-point discrimination of the flaps were 4.6 mm and 3.0 mm, respectively. The technique we applied seems to be an excellent option for 1-stage reconstruction of fingertip or pulp defects.     

Double reverse-flow island flaps for two adjacent finger tissue defect

INTRODUCTION: Soft-tissue reconstruction of fingertip injuries remains a challenge for hand surgery. Tissue loss of multiple digits is a serious problem for hand surgeons. Surgical possibilities include regional, distant and local flaps. In this study, five patients presented with tissue loss of two adjacent fingers and were treated by double reverse-flow island flaps. MATERIALS AND METHODS: The surgical technique is an application of the reverse-flow homodigital island flap for two adjacent finger tissue defects. Instead of one flap, double island flaps are applied to two adjacent finger tissue defects. The flaps are raised from the lateral or medial palmar surface of the proximal phalanx level. Anastomoses between the radial and ulnar digital arteries at the distal interphalangeal joint level are preserved. RESULTS: Three of the patients had tissue defects at the fingertip. In these cases, digital nerve anastomosis with the counter lateral digital nerve made the flaps sensitive. In two patients, the tissue defect was on the dorsum of the middle phalanx level. In these cases, the flaps were non-sensitive. Neither infection nor flap failure was seen in the patients. Sensitive function was satisfactory in fingertip applications. CONCLUSION: The reverse-flow homodigital island flap is a commonly used surgical technique for tissue defects in the fingers. The double reverse-flow island flaps involve the application of this technique for two adjacent fingers. The important point in the surgical technique is that the vascular supply of the two flaps should originate from the same common palmar digital artery. This technique offers a possibility to repair the defects of two adjacent fingers.     

手指皮瓣分类和急诊修复

目的选择应用伤指本体皮瓣和邻指皮瓣重建指端缺损的方式,总结临床应用疗效。方法2001年8月~2005年6月,收治108例112指手外伤,其中男68例71指,女40例41指;年龄16~63岁。损伤原因:均为切削、挤压和撕脱伤,伤后2 h内手术。采取9种皮瓣,对手指指端的急性软组织损伤缺损进行修复.将皮瓣分为两大类:①指动脉主干血管营养皮瓣,包括:指神经血管束V-Y岛状提升瓣,指动脉逆行皮瓣,改良M oberg皮瓣和指神经血管束蒂双翼皮瓣,皮瓣范围2.0 cm×1.5 cm;②指动脉侧支血管营养皮瓣,包括:拇指尺背侧动脉逆行皮瓣,皮瓣范围:1.5cm×1.5 cm~3.0 cm×2.5 cm,指动脉背侧支逆行皮瓣,皮瓣范围1.7 cm×1.0 cm~4.5 cm×3.0 cm;指掌横支皮瓣,其皮瓣范围:2.0 cm×1.0 cm~2.5 cm×2.0 cm;食指背岛状皮瓣和手指局部皮瓣。结果术后3指坏死,3指浅表性坏死。其余106指移位完全成活。术后随访2周~8个月,皮瓣两点辨别觉5~10 mm,指活动良好,外观令人满意。结论选择上述皮瓣可修复所有的末节指端软组织缺损创面,并获得良好的修复外形。     

Dorsally extended digital island flap for repairing soft tissue injury of the fingertip

Background

The digital triangular island flap is one of the most useful types of flap for repairing soft-tissue loss at the fingertip, because it is sensate and has glabrous skin. However, this type of flap has several disadvantages, including limited length of advancement and limited flap size.

Methods

We have developed a new type of dorsally extended digital island flap to extend the reach of the digital triangular island flap. This dorsally extended portion, 15 mm in width and 20 mm in length, is based on the dorsal branch of the digital artery at the distal phalanx level. This island flap has a longer reach than the conventional digital island flap and can transfer larger amounts of soft tissue to the injured fingertip. Sixteen patients with fingertip amputation were treated using this flap.

Results

All of the flaps survived. The dorsally extended digital island flap could repair pulp tissue losses up to 30 mm in length in oblique volar injury. In transverse injury, a new fingertip could be produced with this flap in a single stage. We successfully covered the exposed bone without shortening the digital bone of the fingertip using our extended flap. No claw nail deformity occurred and no flexion contracture remained in any of the cases.

Conclusion

Use of a dorsally extended digital island flap is recommended for repairing fingertip injury in cases with defect sizes ranging from 10 to 30 mm in length and also in both oblique volar and transverse injuries. This flap is more versatile for repair of fingertip injury than the conventional digital island flap.     

The heterodigital reversed flow neurovascular island flap for fingertip injuries.

We report the results of pulp reconstruction with a new heterodigital reverse flow island flap. A dorsolateral flap from the middle phalanx, based on the digital artery is raised from the adjacent uninjured finger. The common digital artery, between the injured finger and the donor finger, is ligated and transected just before its bifurcation. The two converging branches of the digital arteries can be entirely mobilized as a continuous vascular pedicle for the flap. Thus the vascularization is now supplied by reverse flow through the proximal transverse digital palmar arch of the injured finger. To provide sensation the dorsal branch of the proper digital nerve from the donor finger can be included in the flap. Six reverse heterodigital island flaps were used in patients. In five patients the flap was used for pulp reconstruction and in one case for covering a dorsal digital defect. In one case mild venous congestion occurred. Good skin coverage with supple and well-vascularized skin was obtained in each patient. The static two-point discrimination over the flap was between 6 and 15 mm. This new procedure is indicated for extensive pulp defects in fingers in which reconstruction cannot be done using other flaps and as an alternative to microsurgical reconstruction.     

Innervated reverse dorsal digital island flap for fingertip reconstruction

PURPOSE: Various methods of fingertip reconstruction with a sensory flap have been reported. Digital island flaps or cross-finger flaps have to be used for large defects; however, the digital artery is sacrificed when creating conventional homodigital island flaps and 2 surgeries are required for the cross-finger flap. We describe our experience with an innervated reverse dorsal digital island flap that does not require sacrifice of the digital artery. METHODS: We used innervated reverse dorsal digital flaps for fingertip reconstruction in 8 patients. The flap was supplied by the vascular network between the dorsal digital artery (the terminal branch of the dorsal metacarpal artery) and the dorsal branch of the digital artery. Venous drainage was through the cutaneous veins and the venous network associated with the dorsal arterial network. The flap was designed on either the dorsal proximal or the dorsal middle phalangeal region. The flap was harvested with the dorsal branch of the digital nerve (for the dorsal middle phalanx), the dorsal digital nerve (for the dorsal proximal phalanx), or the superficial branch of the radial nerve (for the thumb), which was anastomosed to the distal end of the digital nerve. After flap transfer the donor site was covered with a full-thickness skin graft. RESULTS: Of the 8 flaps, 6 survived completely, 1 had partial epithelial skin necrosis, and 1 showed central compression skin necrosis. Three flaps showed congestive changes from the first to the fifth day after surgery, which resolved by massage. All patients achieved satisfactory recovery of sensation; the static 2-point discrimination ranged from 3 mm to 5 mm and the Semmes-Weinstein test results ranged from 0.036 g to 0.745 g. CONCLUSIONS: The innervated reverse dorsal digital island flap provides another option for homodigital tip coverage. The advantages are that the digital artery is not sacrificed and only 1 surgery is needed. A disadvantage is the potential for venous congestion for the first 4 or 5 days after surgery.     

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects

Background:

Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.

Materials and Methods:

Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.

Results:

Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.

Conclusion:

Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.     

带指神经血管蒂的V - Y岛状推进皮瓣治疗指端皮肤缺损

目的 介绍应用带双侧或单侧指神经血管蒂的V-Y岛状推进皮瓣修复指端皮肤缺损的疗效。方法 对86例102指指端皮肤缺损患者,设计并采用带双侧或单侧指神经血管蒂的V-Y岛状推进皮瓣修复创面。对指端偏背侧、横截面及缺损长度<1.2 cm的偏掌侧皮肤缺损,用双蒂岛状皮瓣修复;对缺损长度在1.2～2 cm的偏掌侧皮肤缺损,用单蒂岛状皮瓣修复。结果 皮瓣全部成活。20指失访,82指术后平均随访13个月。皮瓣覆盖质量满直,指腹二点分辨觉均在正常范围内,但有2指产生残端神经痛。77指冷天皮瓣能耐寒冷皮温正常,5例5指因皮瓣耐寒性差而影响工作。指间关节活动范围基本正常。结论 该皮瓣较传统的V-Y皮瓣具有手术简单、术后外形好、感觉正常、关节活动不受影响等优点;是修复指端皮肤缺损的有效方法之一。     

指背静脉动脉化逆行岛状皮瓣修复指端缺损

目的 介绍一种修复指端缺损的新方法。方法 指背逆行岛状皮瓣通过指端的指动脉与其静脉吻合,形成静脉动脉化皮瓣修复指端缺损10例。结果 所有皮瓣均成活,外形满意。结论 该方法易操作,需一定的显微外科基础,为修复指端缺损提供一种新方法。     

接合两侧指背神经的指动脉终末背侧皮支皮瓣修复指端缺损

目的探讨接合两侧指背神经的指动脉终末背侧皮支皮瓣修复指端缺损的方法和临床疗效。方法2008年8月-2011年8月．采用接合两侧指背神经的指动脉终末背侧皮支皮瓣修复2～5指指端缺损6例,其中食指2例,中指1例。环指2例,小指1例,皮瓣切取面积最大22mm×20mm,最小10mm×9mm。结果6例6指皮瓣全部成活．术后经6～24个月随访,平均13个月,皮瓣外观及手指功能恢复满意,感觉恢复S3,皮瓣两点辨别觉6～9mm,平均7．6mm,供区无并发症。结论接合两侧指背神经的指动脉终末背侧皮支皮瓣具有血供可靠．不破坏重要血管,且有可供接合的神经,操作简便等优点,是修复手指指端缺损较为理想的方法。     

Reverse digital artery island flap in the elderly

The following case report illustrates the successful use of the reverse digital artery island flap in elderly patients. The reverse digital artery island flap is a recognised method of providing good quality soft tissue cover to the amputated fingertip. First described in 1986 by Kojima, Lai and Han have reported their experience of 52 and 120 of these flaps, respectively. The majority of patients in the literature are less than 50 years old, with ages ranging from 3 to 62 years. The flap is based upon reversed flow in the digital artery via a communicating branch from the contralateral artery at a point 5mm proximal to the distal interphalangeal joint crease. In the two cases reported below, we have shown that the indications for this type of homodigital flap reconstruction for fingertip amputations can be safely extended to elderly patients.     

带神经的同指螺旋状顺行岛状皮瓣修复指端缺损

目的 探讨带神经的同指螺旋状顺行岛状皮瓣修复指端缺损的手术效果.方法 2007年3月至2009年6月,对15例指端缺损的患者,在清创术后3～6 d,采用带神经的同指螺旋状顺行岛状皮瓣进行修复.指端皮肤缺损面积为1.5 cn×1.2 cm～2.2 cm×2.0 cm.供区中节指背创面取前臂内侧全厚皮片植皮修复.结果 术后15例皮瓣均未发生血管危象,皮瓣与皮片全部存活.15例随访时间为6～24个月,患指伸、屈功能正常,伤指无疼痛,皮瓣外形满意、质地柔软、有指纹,末节指端静止两点分辨觉为5～6 mm,指侧方静止两点分辨觉为8～10 mm.结论 带神经的同指螺旋状顺行岛状皮瓣修复指端缺损,手术方法简单、可靠,效果满意,是修复指端缺损的一种理想的手术方法.     

指神经血管蒂推进皮瓣修复指端缺损

目的 介绍指掌侧血管神经蒂推进皮瓣修复指端缺损的方法和临床效果.方法 按Littler法,在指残端设计皮瓣,分离血管神经蒂,以增加皮瓣推进距离,用于重建长度在2.2cm范围内的指端创面.1998年以来,应用6例,指端创面长度1.5-2.2cm.结果 皮瓣全部成活,随访3-12月,外形,感觉满意.结论 指掌侧血管神经蒂推进皮瓣,手术简单,效果确切,可修复长度在2.2cm范围内的指端缺损.     

缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣术后供区皮肤缺损

目的：探讨采用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣切取后指神经裸露及软组织缺损的方法及疗效。方法应用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣移植后供区软组织缺损20例21指,软组织缺损面积：1.5 cm×2.0 cm～2.0 cm×3.0 cm。随访检测患指皮瓣外观、关节活动度及感觉等指标。结果术后20例皮瓣全部成活。术后经5个月随访,修复后患指指动脉皮瓣供区外形饱满,质地柔软,局部皮肤感觉及供区各关节活动范围令人满意。结论采用缝合神经的掌骨背逆行筋膜蒂皮瓣修复逆行指动脉皮瓣切取后供区指神经裸露及软组织缺损是有效而简单的方法,并可获得良好的外形及功能。     

One-stage coverage of multi-digital pulp defects with sensate flaps from the foot

BackgroundThe reconstruction of the digital pulp defects was a mix of the sensation, function, and aesthetics. As the conventional flaps became out of date, the sensate flaps were increasingly utilized in covering such defects. In this report, we present our experience with some novel flaps design, located on the foot.MethodFrom April 2015 to September 2018, nine patients received the free sensate flaps to resurface soft tissue defects in the multi-digital pulps. And all flaps were harvested from each aspect of the foot, which dimensions were tailored to the defects. The cutaneous nerve was preserved within the flap. Standardized assessment of outcome in terms of sensory, functional, and esthetic scores of the reconstructed pulps was completed.ResultsNineteen flaps survived completely without significant complications, and mild venous congestion was observed in one flap. The free sensate flaps were performed for digital pulp reconstruction in 9 patients: 6 male and 3 female patients with a mean age of 49 years (ranged, 16 to 72 years). The defects involved 3 thumbs, 6 index fingers, 5 long fingers, 3 ring fingers, and 2 little fingers. All flaps were available for a mean follow-up of 30 months (ranged, 24 to 36 months). The functional and esthetic outcomes were satisfied for all flaps, as well as the sensory restoration.ConclusionThe sensate flap from the foot is a remarkable alternative for digital pulp reconstruction with less morbidity and better outcomes. Furthermore, the foot region presents a sensitive, glabrous skin with the proper bulkiness and allows for easy dissection.     

同指背侧皮神经营养血管皮瓣修复指端缺损

目的 总结同指背侧皮神经营养血管皮瓣逆行转移修复指端软组织缺损的临床效果.方法 于伤指近节背桡侧或背尺侧(拇指为第一掌骨背桡侧或背尺侧)设计皮瓣,深筋膜下锐性分离,逆行转移修复指端缺损.如修复指腹,将皮瓣携带的皮神经与伤指指固有神经相缝合,重建感觉功能.结果 临床应用31例39指,1例皮瓣远端1/3部分出现坏死,换药后愈合;4例出现张力性水泡,表皮脱落后皮瓣存活;其余皮瓣均全部存活.结论 该类皮瓣切取简单,外观好,对供区损伤小,转移随意性强,并可重建皮瓣感觉功能,是修复指端软组织缺损较为理想的方法.     

六种皮瓣修复拇指腹缺损的远期疗效观察

目的评价6种皮瓣修复拇指腹缺损的远期疗效.方法对2001年12月前,在我科接受6种皮瓣修复拇指腹缺损（锁骨下带蒂皮瓣、手指掌侧推进皮瓣、示指背侧皮瓣、带血管神经蒂的大鱼际近端皮瓣及趾腹游离皮瓣）共142例患者,进行了远期随访.随访内容有术后拇指腹色泽、外形、质地、出汗情况、拇指的痛觉、触觉、两点分辨觉、综合质地感觉及运动功能等.结果142例均获得了完整资料.6种皮瓣中,其中锁骨下带蒂皮瓣与示指背侧皮瓣修复的拇指腹,从皮肤色泽、外形、质地、出汗情况等均比其它4种皮瓣差,综合质地感觉优良率也明显低于其它4种皮瓣.结论手指掌侧推进皮瓣、指侧方血管蒂岛状皮瓣、带血管神经蒂的大鱼际近端皮瓣及趾腹游离皮瓣修复拇指腹缺损远期临床效果良好,但指侧方血管蒂岛状皮瓣对手部创伤较大,影响患手美观及供区手指的感觉.     

中环指岛状皮瓣、示指背侧岛状皮瓣转移修复拇指损伤

目的 评价中环指岛状皮瓣和（或）示指背侧岛状皮瓣转移修复拇指损伤的疗效。方法 １９８９年７月￣１９９８年１１月共８例拇指损伤应用中环指岛状皮瓣和（或）示指背侧岛状瓣修复。其中示指侧同状皮瓣转移修复拇指损伤２例,中指尺侧岛状皮瓣加示指背侧岛状岛状皮瓣转移修复拇指脱套伤１例,中环指双岛状皮瓣转移修复拇指撕脱离断伤１例。中指尺侧岛状皮拇指损伤４例。随访７个月－９年１１个月,平均５年１个月,主要观察皮     

指神经血管蒂逆行岛状皮瓣急诊修复指端缺损

目的 报道应用指神经血管蒂逆行岛状皮瓣修复指端缺损的临床效果。方法 应用显微外科技术，采用指神经血管蒂逆行岛状皮瓣修复指端缺损，术后配合适宜的功能训练，共治疗指端缺损32例45指。结果 皮瓣全部成活，术后随访1年以上，皮瓣颜色、质地基本正常，精细感觉恢复（S3＋）及感觉恢复正常（S4）占75．6％，手指活动比较自如。结论 指神经血管蒂逆行岛状皮瓣能确保皮瓣血运，可以恢复手指端感觉，适于指端缺损的修复。