同指螺旋岛状皮瓣修复指腹缺损

目的：探讨同指螺旋岛状皮瓣修复指腹缺损的方法和临床疗效。方法：自2007年6月至2009年10月,采用以同指一侧指固有神经血管柬为蒂螺旋岛状皮瓣向前推进修复指腹缺损16例16指,男12例,女4例;年龄18～49岁,平均37岁。机器挤伤11例,重物砸伤2例,车门挤伤1例,电锯伤2例。损伤指别：食指5例．中指9例,环指2例。均为全指腹缺损,缺损范围：1．6cm×1．2cm-2．5cm×1．7cm,指背供区植皮。结果：皮瓣全部成活,创面I期愈合,全部病例均获随访,时间8-20个月,平均12个月,手指外形良好,皮瓣质地软,静止两点辨别觉为5～7mm,平均为5．1mm。按照手指总主动活动度评级标准（TAM）,优7例,良8例,中1例。结论：采用同指螺旋岛状皮瓣修复指腹缺损,手术操作简便,可获得良好临床疗效。     

缝合双侧指神经背侧支的改良邻指皮瓣重建指腹感觉

目的 探讨缝合双侧指神经背侧支的改良邻指皮瓣移位重建指腹感觉的手术效果.方法 2005年5月-2008年5月,对33例指腹皮肤缺损的患者,采用缝合双侧指神经背侧支的改良.邻指皮瓣进行转移修复.结果 术后33例皮瓣全部存活,经3～9个月随访,功能及外观良好,两点分辨觉为5～7 mm,平均6.3 mm.结论 该术式不损伤手指的主要神经和动脉,皮瓣感觉恢复良好,是重建指腹感觉的一种可行手术方法.     

缝合双侧指神经背侧支的改良邻指皮瓣重建指腹感觉

目的 探讨缝合双侧指神经背侧支的改良邻指皮瓣移位重建指腹感觉的手术效果.方法 2005年5月-2008年5月,对33例指腹皮肤缺损的患者,采用缝合双侧指神经背侧支的改良.邻指皮瓣进行转移修复.结果 术后33例皮瓣全部存活,经3～9个月随访,功能及外观良好,两点分辨觉为5～7 mm,平均6.3 mm.结论 该术式不损伤手指的主要神经和动脉,皮瓣感觉恢复良好,是重建指腹感觉的一种可行手术方法.     

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.     

同指顺行岛状皮瓣移位修复指腹缺损

目的探讨同指带指神经血管蒂顺行岛状皮瓣移位修复指腹缺损的手术效果。方法2003年11月~2005年2月,30例32指指腹缺损患者,男25例,女5例。年龄18~56岁。创面经彻底清创,应用抗生素治疗2~8d后行同指带指神经血管蒂顺行岛状皮瓣移位修复。缺损范围为1.5cm×1.2cm~3.5cm×2.1cm。皮瓣设计在同指的尺背侧或桡背侧,皮瓣远端距甲根不<5mm,避免损伤甲基质,近端不超过中节指横纹,腹侧切口不超过手指中线,背侧切口不超过手指背中线。切取皮瓣范围为2.0cm×1.5cm~4.0cm×2.5cm。供区创面切取上臂内侧带真皮下血管网皮片植皮。结果术后30例32个皮瓣全部成活,未发生血管危象。25例获随访2~8个月。皮瓣质地血运良好,外形满意,两点辨别觉7~10mm,手指伸展、屈曲活动功能基本正常。结论同指带指神经血管蒂顺行背侧方岛状皮瓣移位,手术方法简便、安全,效果满意,是修复拇、手指指腹缺损的一种较好方法。     

Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery

Volar-oblique injuries of the thumb pulp are particularly disabling. Many methods have been described to treat these injuries and provide return of sensibility. The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. We review our experience with this flap and describe technical refinements that have contributed to improved early outcome and long-term neurosensory recovery. Thirty patients underwent 31 cross finger flaps to the thumb for volar-oblique pulp defects. Defect sizes ranged from 1.5 to 5 cm in length and 1.5 to 3 cm in width. Dorsal skin of the index finger proximal phalanx was used in 26 patients, index finger middle phalanx in 2 patients, and long finger middle phalanx in 3 patients. Nine patients were available for long-term follow-up and were subjected to functional assessment (DASH questionnaire), sensitivity testing (2-point discrimination, Semmes-Weinstein monofilament testing), and range of motion evaluation. Thirty of 31 flaps survived. In 1 patient, trauma to the attached flap from the long finger middle phalanx resulted in flap ischemia. This was revised with a fresh cross finger flap from the index finger proximal phalanx. Employed patients were able to return to their original jobs. Recalled patients (n = 9) were assessed at a mean of 29 months after surgery (range, 12-70 months). All recalled patients regained normal sensibility on 2-point discrimination testing. Functional outcome was satisfactory in 8 patients (DASH score, 0-20). The last patient (DASH score, 61.67) complained of hypersensitivity and cold intolerance that affected his work. The conventional cross finger flap provides reliable coverage for volar-oblique hemipulp losses of the thumb, with patients regaining at least protective sensibility in the long term. The proximal and middle phalanges of both the index and long fingers may serve as donor sites, allowing the surgeon to best select skin cover based on defect size and options in finger positioning.     

改良指背筋膜蒂皮瓣修复指腹软组织缺损

目的探讨改良指背筋膜蒂皮瓣修复指腹软组织缺损的临床效果。方法2018年6月至2019年3月,皖南医学院第一附属医院手足外科收治14例指腹缺损患者,男12例,女2例,年龄27~63岁,平均49岁。指腹缺损创面面积1.6 cm×1.4 cm~2.5 cm×1.6 cm,以患指背侧筋膜为蒂部设计皮瓣,旋转点不超过中节指骨的中点水平。倒L形切断远侧指间关节水平筋膜组织后翻转筋膜蒂及皮瓣,修复指腹缺损。近节供区以前臂全厚皮片移植修复。记录皮瓣术后存活情况,随访观察皮瓣外观、两点辨距觉,根据关节总活动度法对手功能进行评价。结果14例皮瓣全部成活,皮瓣大小1.8 cm×1.6 cm~2.7 cm×1.8 cm,其中1例皮瓣远端出现水泡,抽液换药后自行愈合。14例均获得5~12个月随访,平均8.9个月。皮瓣外观质地与周围组织相近,外观满意,末次随访评定手功能:优9例,良5例。皮瓣两点辨距觉8~11 mm,平均9.9 mm。结论改良指背筋膜蒂皮瓣切取简单、重建效果满意,可得到良好的临床效果。     

Finger palmar surface reconstruction using medial plantar venous flap: possibility of sensory restoration without neurorrhaphy

BACKGROUND: Because plantar anatomic features are similar to those of the palmar surface of the finger, palmar surface finger reconstruction using a medial plantar venous flap enables grasping without slippage, results in strength that can withstand friction, and provides a cushioning effect. Furthermore, sensory restoration is thought to be excellent due to the similarity of the tissues. METHODS: We performed finger palmar surface reconstruction in 6 patients using venous flap without harvesting the medial plantar subcutaneous nerve branch and assessed the sensory restoration using a static 2-point discrimination test (s-2PD), moving 2-point discrimination test (m-2PD), and Semmes-Weinstein test (S-W test). RESULTS: The mean s-2PD at 12 months after surgery was 8.6 mm, the mean m-2PD was 6.00 mm, and the S-W test score was 3.84-3.22 CONCLUSION: These findings indicate that sensory improvement can be obtained by finger palmar surface reconstruction without grafting of the medial plantar subcutaneous nerve branch to the digital nerve.     

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.     

趾腹腓侧皮瓣移植修复指腹缺损

目的　介绍游离趾腹腓侧皮瓣移植修复拇、手指腹缺损的临床效果。方法　 2 0 0 0年 9月起 ,亚急诊行游离趾腹腓侧皮瓣修复拇、手指全指腹缺损 6例。结果　 6例皮瓣全部成活 ,术后随访 3个月～ 3年 ,拇、手指外形满意 ,皮瓣两点分辨觉达 6～ 10mm ,手指活动功能良好。结论　趾腹腓侧皮瓣移植术是修复拇指指腹缺损的首选方法 ,也适用于修复示、中指指腹缺损。     

Reconstruction of Composite Soft Tissue Defect in the Distal Finger Using Partial Toenail Flap Transfer

Objective

Composite tissue loss involving the distal finger pulp and the nail is a common but challenging finger injury to restore. This study introduces a reconstruction procedure for a distal finger pulp and nail defect using a partial toenail flap transfer.

Methods

Twenty digits, including 16 thumbs, two index fingers, and two middle fingers, with composite soft tissue defects were treated with a partial toenail flap transfer from October 2015 to January 2020. Shortening revision of the great toe phalanx, a V-Y advancement flap of the toe pulp, and a local pedicle flap from a second toe transfer were used to cover the donor sites, and no skin grafts were required. Functionality was evaluated using the validated Spanish version of the Quick-DASH scale. The aesthetics of both the reconstructed and donor sites were evaluated using the Vancouver Scar Scale (VSS). The static two-point discrimination (2-PD) of the finger pulp was used as a measure of tactile agnosia.

Results

All donor site wounds healed well. The average follow-up time was 23.6 months (6–39 months). The mean Quick-DASH functional score was 7.1. The VSS scores were 4.02 ± 0.29 and 4.00 ± 0.38 for the reconstructed and donor sites, respectively. The static 2-PD of finger pulp was 4.5 ± 0.76 mm. The patients were satisfied with finger motion, sensory function, and aesthetic contour.

Conclusions

Partial toenail flap transfer is the recommended treatment to regain motion, sensation, function, and a satisfactory aesthetic appearance when considering repairing a composite soft tissue distal finger defect with accompanying loss of the perionychium, particularly in the thumb, index finger, or middle finger.     

桡动脉浅支皮瓣修复指腹缺损的临床应用

目的 探讨桡动脉浅支皮瓣修复指腹缺损的手术疗效.方法 设计游离桡动脉浅支皮瓣修复指腹缺损20例.指腹皮肤缺损范围1.5 cm ×2.5 cm～3.5 cm ×2.0 cm.以桡动脉浅支走行于腕掌侧设计皮瓣,于皮瓣近端切取正中神经掌皮支重建感觉.结果 20例移植皮瓣全部成活,未发生血管危象.随访6～12个月,皮瓣质地血运良好,外形满意,两点辨别觉5～7 mm,手指伸展、屈曲活动正常.结论 游离桡动脉浅支皮瓣切取方便、供区损伤小,是修复手指指腹缺损的一种较好方法.     

Lateral-dorsal neurovascular island flaps for pulp reconstruction

Finger pulp loss is often observed in daily practice. When the lateral and dorsal surfaces of the injured digit remain intact, a neurovascular island flap can be designed and raised from that part of the finger for pulp reconstruction. Two types of homodigital lateral-dorsal neurovascular island flaps were used in 17 patients (13 type I and 4 type II) for reconstruction of traumatic pulp loss on an emergent basis. The type I flap was used for the pulp defect less than 2.5 cm in length; the type II flap was designed for extensive pulp loss. The size of the pulp defect varied from 1.7 x 1.2 cm to 3.8 x 1.7 cm. All flaps survived completely without any partial loss. The mean follow-up was 17.7 months. The mean static two-point discrimination was 5.2 mm in type I flaps and 9.3 mm in type II flaps. All patients except five had full range of motion of the interphalangeal joint. These five patients (3 type I and 2 type II) had 10 to 20 deg reduction in flexion of the distal interphalangeal joints. The homodigital lateral-dorsal neurovascular island flap offers a durable, well-vascularized, sensate skin flap for one-stage pulp reconstruction in select patients. This technique is relatively simple, allows early postoperative mobilization, and has an acceptable surgical outcome.     

趾部游离皮瓣修复指腹缺损的临床应用

目的 总结应用趾部游离皮瓣修复手指指腹缺损的临床效果.方法 对手指指腹缺损采用第一足趾腓侧或第二足趾胫侧游离皮瓣修复25例,皮瓣切取面积大小为2.0 cm×3.0 cm～3.5 cm×4.5cm,进行趾底动脉.指固有动脉,皮下静脉-指背静脉吻合重建皮瓣血液循环,趾底神经-指同有神经重建感觉.结果 25例皮瓣全部成活,术后出现血管危象2例,行手术探查后重新吻合血管成活,3个月后行皮瓣整形手术12例.术后随访2个月～2年,平均10个月,手指功能与外观均满意,指腹饱满,感觉及运动恢复正常,两点辨别觉为4～6 mm.结论 应用趾部游离皮瓣修复手指指腹缺损可获较好的临床效果.     

急诊修复拇指指腹缺损三种方法的研究

目的 报道采用不同方法急诊修复拇指指腹缺损的疗效。方法 采用示指背侧岛状皮瓣，拇指桡侧指动脉逆行岛状皮瓣转位有趾腹皮瓣游离移植三种方法，为21例线指指腹缺损进行急诊修复。结果 20例以瓣成活，1例失败。术后随访半年－2年，平均10个月。所有皮瓣血运，弹性，质地均良好。指腹二点分辨觉：示指背侧岛状皮瓣平均为92.mm，拇指桡侧动脉逆行岛状皮瓣平均为8mm，趾腹皮瓣平均为5.6mm。结论 急诊修复拇指指腹缺损首选趾腹皮瓣，其次为拇指桡侧指动脉逆行岛状皮瓣或示指背侧岛状皮瓣。     

Restoration of thumb sensibility with the innervated first dorsal metacarpal artery island flap

PURPOSE: This study investigated the quality of sensibility from innervated first dorsal metacarpal artery (FDMCA) island flaps in younger and older patients and evaluated the donor site morbidity at the index finger. METHODS: Twenty-five patients with an innervated FDMCA island flap to restore sensibility of the thumb were divided into groups according to age (>50 or <50 years). Sensory recovery and cortical reorientation were tested with Semmes-Weinstein monofilaments, a calibrated 2-point discrimination tester, and needle prick testing. Donor site morbidity was evaluated for range of motion, aesthetic appearance, pain, and problems with injuries. RESULTS: The mean age of the patients was 48.3 years and the mean follow-up period was 3 years. The 14 patients older than 50 years had a static 2-point discrimination (s2-PD) of 10.9 mm compared with 10.8 mm of the 11 patients younger than 50 years. The average loss of s2-PD of the flap compared with the donor area averaged 2.7 mm in all patients. Complete cortical reorientation occurred in 7 patients older than 50 years and in 5 patients younger than 50 years. Total loss of range of motion of all donor finger joints was 14 degrees (4.4%) compared with the contralateral index finger. Twenty-two patients were satisfied with the result. CONCLUSIONS: There were no age-related differences in the surgical results of the innervated FDMCA island flap and the donor site morbidity was negligible.     

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.     

指动脉皮瓣与超薄腹部皮瓣在末节指再造中的联合应用

目的探讨指动脉岛状皮瓣与超薄腹部皮瓣在末节指再造中联合应用的临床治疗效果。方法指动脉岛状皮瓣转位置于掌侧,超薄任意腹部皮瓣修复大部分缺损创面,进行末节拇、手指再造10例。结果再造指全部成活,经5～12个月随访,2例需二期整形,再造指腹、指端两点辨别觉6-10mm,外形及功能满意。结论指动脉岛状皮瓣与超薄腹部皮瓣联合应用为末节指再造提供一种较实用的方法。     

同指双侧指动脉顺行岛状皮瓣修复指端缺损

目的总结双侧指动脉顺行岛状皮瓣修复指端缺损的临床疗效。方法2010年12月-2012年8月，采用双侧指动脉顺行岛状皮瓣修复指端软组织缺损13例，面积最大为22mm×25mm，最小为12mm×18mm。结果13例皮瓣全部成活，伤口愈合良好。术后随访3-12个月，皮瓣外形满意、质地柔软、弹性良好．两点辨别觉达6～8mm，手功能TAM法评定：优12例，良1例，优良率100％。结论该手术方法操作简便、安全，术后效果满意，是修复指端缺损较为理想的方法。     

Free toe pulp flap for finger pulp and volar defect reconstruction

Background:Fingertip injury requiring flap cover is very common in the modern era. The ideal cover should fulfill both functional and aesthetic improvement.Results:Five flaps survived completely, one suffered partial loss, and one flap failed completely. The median follow-up period was 9 months. The median duration of surgery was 255 min (range 210 to 300 min). The median two-point discrimination was 6.5 mm (range 4–8 mm). There was the return of temperature sensation in all patients; two had cold intolerance. The Semmes-Weinstein monofilament score varied from 3.61 to 5.07 (median filament index value 4.31/pressure value of 2 g/mm²). Three patients had delayed donor site wound healing.Conclusions:The free toe pulp flap is an efficient choice for fingertip and volar finger defects reconstruction with an excellent tissue match.KEY WORDS: Finger defect, free toe pulp flap, pulp defect, reconstruction, volar defect