Reconstruction of distal phalangeal injuries with the reverse homodigital island flap

Reconstruction of extensive distal phalangeal defects with exposure of tendon, bone, or joint can be particularly a difficult problem. For assessment of the value of the reverse homodigital island flap patients with distal phalangeal avulsion and crush injuries who were treated from January 2005 to April 2006 were analysed retrospectively. Main outcome measurements included flap survival rate, sensory restoration, occurrence of cold intolerance, length of occupational disability, and joint mobility. Eleven patients were included in the study. Only one patient suffered from venous congestion with partial flap necrosis, requiring debridement with subsequent skin grafting. The minimum follow-up was 6 months. The static 2-point discrimination had a mean value of 9 mm. None of our patients complained of cold intolerance or residual joint contracture. All patients returned to full occupational activity within an average time period of 4.5 weeks. In conclusion, the reverse homodigital island flap is an excellent option for 1-stage reconstruction of distal phalangeal defects.     

Complications of the reverse homodigital island flap in fingertip reconstruction

Twenty-four digital artery island flaps with reversed flow were used to reconstruct 23 patients with fingertip injuries in the authors' clinic between June 1998 and August 2000. No nerve coaptation was performed in these patients. Patient age ranged between 18 and 35 years. All patients were evaluated at clinical follow-up for active range of motion, appearance, patient satisfaction, two-point discrimination, hypersensitivity and cold intolerance, previous hand injury, and flap viability in the repaired finger. Based on their experience, the authors consider that this procedure has several disadvantages: relatively high flap loss, sacrifice of one of the two major arteries of the finger, it is a time-consuming method, it is a difficult flap dissection, there is a requirement for loupe and microsurgical equipment. The authors think that this flap should not be the first choice for fingertip reconstruction especially for patients who have possibility of reinjuring their hands because of their jobs.     

The homodigital neurovascular antegrade island flap for fingertip reconstruction in children

We describe a homodigital neurovascular island flap for fingertip reconstruction in children and review the appearance and function of the reconstructed fingertips. Eleven children, with a mean age of 4 years (range: 2-7),who had sustained a fingertip injury with total or subtotal pulp loss were treated with a homodigital neurovascular island flap between 2007 and 2009. The flaps were harvested based on a single digital neurovascular bundle without further shortening of the distal phalanx. The average follow-up period was 15 months (range: 10-32 months). The clinical outcome evaluations included the defect size of the flap, the static two-point discrimination, total active motion (TAM) of the PIP and DIP joints and time to return to daily activities. Patient satisfaction with function and cosmesis were also evaluated. All of the flaps survived without any painful scar formation, hypersensitivity or cold intolerance and no interphalangeal joint contractures were noted. The average two point discrimination ranged from 3 to 4 mm, with an average of 3.4 mm. All the patients were satisfied with the function and appearance of the involved finger. Our study suggests that the homodigital neurovascular is a reliable choice of treatment for children fingertip defects.     

腭部岛状瓣在重建磨牙后区缺损中的临床应用

目的:评价腭部岛状瓣在重建因肿瘤切除导致的磨牙后区组织缺损中的临床应用.方法:回顾性分析我科2001年5月～2010年8月收治21例腭部岛状瓣修复磨牙后区缺损患者,男女比例为:16/5,平均年龄45岁(24～74岁),肿物良性恶性比例为:4/17.缺损范围3cm×2 cm～5cm ×3cm.所有病例均采用腭部岛状瓣修复缺损部位,术后2至5天(平均3.5天)行口腔进食.结果:20例病例获得一期愈合,1例获得二期愈合.所有病例供区未出现术后并发症;21例患者经6个月～7年的随访,腭部岛状瓣修复区粘膜与附近正常及对侧粘膜的层次和颜色、弹性、光滑度、质地无明显差异,咀嚼摩擦和食物刺激无明显影响.结论:修复磨牙后区缺损,腭部岛状瓣易于制取,是一种可靠的方法.     

远端蒂指背皮神经营养血管皮瓣修复指腹创伤缺损

目的介绍应用指背皮神经营养血管皮瓣修复指腹创伤缺损的临床经验,并探讨改善静脉回流的方法。方法自2004年3月至2005年10月,共急诊应用远端蒂指背皮神经营养血管皮瓣,修复指腹创面大于2 cm者18例。旋转轴点在近侧指间关节(PIP)平面以近0．5 cm,皮瓣面积2 cm×2 cm～3 cm×4 cm,皮神经筋膜蒂长2～3 cm。均将指背皮神经与指固有神经吻接,并在旋转点远侧1 cm处结扎指背浅静脉。结果术后皮瓣均有不同程度的静脉淤血肿胀,8例皮瓣出现张力水泡。13例随访超过6个月,皮瓣恢复保护性感觉。结论指背皮神经营养血管皮瓣修复指腹创伤缺损,方法简单,成活可靠。在蒂部远侧结扎指背浅静脉干阻断倒灌和在末端旷置敞开,均能改善静脉回流,减轻皮瓣肿胀。     

Supratrochlear island flap for reconstruction of the periorbital and nasal defects

Background

The reconstruction of nasal and periorbital defects has been a challenging task for plastic surgeons in terms of obtaining aesthetic and functional results. So far, many surgical methods have been described for the closure of these defects; however, the lack of sensation and inadequate cosmetic appearance were the main disadvantages of these procedures.

Methods

This study involved all patients who underwent reconstruction of nasal and periorbital defects due to tumor resection by means of a supratrochlear artery island flap, between 2007 and 2011. Doppler USG on the frontal region was routinely performed on all of the patients.

Results

This technique was used in six male patients with a mean age of 59.6 years (ranged, 44–68 years).The flap sizes ranged from 3?×?2.2 to 5?×?4.5 cm (mean 3.83?×?3.13 cm). The mean follow-up period was 23.6 months. All of the flaps survived without any problem, and no total or partial loss of flap was observed. The defects were closed with sensate and durable skin. Temporary loss of sensation on frontal regions was observed on all of the patients, but it decreased within 8–12 months in the follow-ups.

Conclusions

The supratrochlear artery island flap is a good alternative for the reconstruction of small- and medium-sized periorbital and nasal defects that offers a single-stage procedure, good perfusion and drainage, reliability, technical easiness, and sensorial superiority. Level of Evidence: Level IV, therapeutic study.     

Vascularized tendon incorporated in reverse homodigital and heterodigital island flaps for the reconstruction of dorsal digital defects

Background: An adequate range of motion (ROM) of the distal interphalangeal (DIP) joint is indispensable for fine motor skills of the hand. Reconstruction of extended skin and tendon loss of the distal phalanx is often challenging for surgeons and may lead to functional impairment of the injured finger. This article presents an option for a one-step functional and esthetical reconstruction of dorsal digital defects using combined island flaps. Methods: Vascularized tendons were harvested incorporated in reverse homodigital and heterodigital island flaps to treat skin and extensor tendon loss of patients over their DIP joints. In a 6-month follow-up, we evaluated the active ROM and fine motor skills of the involved fingers as well as the patients' satisfaction. Results: Six months postoperatively satisfactory functional and sensory results of the donor site finger have been reported. The mean ROM for the recipient finger was 0°/25° for the DIP joint. All flaps remained viable and full finger length was preserved. Patients stated adequate till high satisfaction with respect to operation time, pain, and finger appearance. Conclusion: The vascularized tendon incorporated in reverse island flaps provides a sufficient method to restore function of the DIP joint after complex injury and prevents finger deformity, arthrodesis, or amputation.     

指背筋膜蒂逆行岛状皮瓣修复指远端皮肤软组织缺损38例

目的探讨指背近节筋膜蒂逆行岛状皮瓣修复指远端皮肤软组织缺损的临床疗效。方法2008年3月-2011年1月，对38例（43指）远端皮肤软组织缺损者，采用指背筋膜蒂逆行岛状皮瓣旋转修复。供区行全厚皮片移植。结果本组皮瓣全部成活，术后随访3-16个月，指外观和功能良好，皮瓣饱满，弹性质地好，无色素沉着，两点辨别觉5-9mm。供区植皮成活，愈合满意。结论指背近节筋膜蒂岛状皮瓣解剖恒定、操作简便、蒂部宽松，是治疗同侧指远端皮肤软组织缺损一种较好的手术方法。     

指背岛状筋膜瓣在手部软组织缺损修复中的应用

目的　探讨一种修复指背软组织缺损的有效方法 ,并扩大其应用范围。方法　利用指掌侧动脉与指背侧动脉系统之间的动静脉吻合网 ,形成指背岛状筋膜瓣 ,修复同指背侧软组织缺损 ;将其与同指指动脉神经蒂岛状皮瓣串联后可修复手部其他部位软组织缺损。结果　手外伤急诊应用 39例 ,效果良好。结论　指背岛状筋膜瓣是I期修复同指指背软组织缺损的有效方法 ,与同指指动脉神经蒂岛状皮瓣串联可扩大其应用范围     

指背筋膜脂肪翻转皮瓣修复指腹缺损

目的　介绍应用指背筋膜脂肪翻转皮瓣 ,修复因外伤引起的屈指腱鞘和屈指肌腱的裸露创面的临床效果。方法　指背筋膜脂肪翻转皮瓣包括以指动脉背侧支血管为蒂的同指背所有的筋膜脂肪组织 ,翻转修复指掌侧的软组织缺损伴屈指肌腱暴露的创面。结果　本组 5例患者 ,行指背筋膜脂肪翻转皮瓣修复术后皮瓣均成活 ,临床效果满意。结论　指背筋膜脂肪翻转皮瓣修复指腹缺损的手术方法具有操作简单、血供恒定、外形恢复令人满意、有利于手屈指功能恢复等优点。此手术方法非常适合指掌侧的组织重建