In these cases, it was decided not to perform neurorrhaphy with the contralateral nerve. The secondary defect, created in the donor area, was closed primarily or covered with a skin graft removed from the hypothenar region. The tourniquet was released and perfusion was observed Figs. Regarding the etiology, seven patients suffered injuries from blunt trauma or crushing, and one patient from chemical burns. As complications, two patients presented a positive Tinel sign at the donor area of the flap, and one reported cold intolerance. Table 3 presents a complete description of the quantitative variables.
The mean time to return back to work was seven weeks Table 3. Three patients No cases of partial or total necrosis of the surgical flap or retractions or contractures in flexion were observed. Digital pulp lesions are of great importance due to their high prevalence and possible harm to the patient, whether physical, emotional, work-related, or esthetic.
The size of the lesion, the association with amputation, the quality of the donor area, the experience of the surgeon, and the profile of the patient should be taken into account. Local flaps are preferred due to technical simplicity, and the fact that the receiving area has the same characteristics. This variable diverges from the results of the study by Huang et al. The follow-up time observed in the literature was quite heterogeneous, ranging from six months to nine years.
Regarding etiology, trauma was the most common cause. Acar et al. The mean flap area was Most patients maintained the range of motion Regmi et al. As a disadvantage, the homodigital flap presented decreased sensation when assessed by specific tests. In the Semmes-Weinstein test, 11 all patients responded to the purple filament, that indicates decreased protective sensation of the hand. The results were similar in comparison with other authors. The mean of the two-point discriminatory test was 7.
According to statistical data in the literature, the mean distance in the two-point discrimination test is 6 mm for innervated flaps and 9 mm for non-innervated flaps. In the present study, the main complications were the persistent Tinel sign in two patients Acar et al. No cases of venous congestion or flexion contracture were observed; in the systematic review performed by Regmi et al.
Repair of multiple finger defects using the dorsal homodigital island flaps - 中国知网
In the present sample, no patient complained of limitation of daily activities or work. On average, patients returned back to work after seven weeks, similar to that found by other authors. The homodigital flap surgical technique presented satisfactory esthetic and functional results regarding the viability, mobility, and esthetics of the finger, with sufficient sensation to prevent lesions.
Table 1. Distribution by finger. Finger 4 1 Table 2. Semmes-Weinstein monofilament test. Difficulties in discriminating shape and temperature Purple disk Dark red nominal: 4. Vulnerable to injury.
Surgical technique. Digital pulp volar lesion a. Flap design b.
Flap with pedicle c. Final appearance, donor area graft and flap rotation d. Final volar appearance e. Superior view of the affected hand a. Axial view of the fifth finger b. Healed surgical wound c. Finger flexion d. Immediate postoperative period a. Palmar aspect showing scar tissue on the radial side of the third finger b.
In the physical exam, there was a soft tissue defect in dorsal hand. She could not extend the left 3rd, 4th and 5th fingers. Distal pulse and capillary refill were normal. There was no bone injury; there were extensor tendons defect about 6 cm length and soft tissue defect about 6 - 12 cm. The wound was dirty and full of debris.
After serial irrigation and debridement of necrotic tissue and foreign body, the injection of antibiotic and tetanus prophylaxis, the patient was scheduled for flap. There are two options to reconstruct extensor tendons: covering soft tissue alone and postponing tendon reconstruction, extensor tendon reconstruction with silicon rod and soft tissue coverage concurrently Although the latter method had a few proponents, the second method was employed.
Therefore, silicon rod was inserted for extensor tendons and then random pattern abdominal flap was inserted Figure 1B and 1C ; three weeks later the pedicle of flap was separated and three months later silicon rods were removed. Therefore, extensor tendons with palmaris longus and plantaris tendon graft were reconstructed Figure 2A. Silicon produces pseudosheet around flexor sheet to prevent subsequent adhesion. There are many options such as regional flap, distant flap or free flap to cover the dorsal hand soft tissue. Some of them need microsurgery skills and take a long time 11 - Regional forearm flap causes extensive scar in the donor site.
It was not accepted by the patient, and on the other hand regional forearm flap is used for small soft tissue defect Totally, there was a concern about risk of infection due to silicon rod in acute setting; the second method was employed to lessen several surgeries and avoid adhesion.
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Advantages of this method are: no need to microsurgery skills, no need to long time operations, no need to extensive scars in upper limb and prevention of extra operation for extensor reconstruction. Disadvantages of this method are: possibility of infection, possibility of need to debulking. The first stage for debulking was made three months later, a half of flap was debulked and then three months later the other half was debulked again. Finally, the patient could extend her fingers and gradually, the range of motion increased Figure 2B , 2C. Flow-through, functioning, free musculocutaneous flap transfer for restoration of a mangled extremity.
J Reconstr Microsurg. All patients with 23 wounded fingers survived from orthodromic island flap prosthetics of homo-digital artery, and all wounds healed by the first intension after operation. There was no blood-supply disturbance in volar and dorsal fingers and cicatricial contracture. According to TAM detection of hand functions  , flaps were excellent healed in 19 cases, good and fairish in 1 case respectively, with effective rate being.
Repair of multiple finger defects using the dorsal homodigital island flaps.
Additionally, the application of free flaps of toe flanks for finger pulp defect could obtain favorable appearance and sensation, but the operation was complicated with long surgical time and higher requirement on microscope, which made it difficult to be routinely promoted . The principles of flap prosthetics were as follows  : flaps containing vascular pedicle of digital nerve without damaging the main truck of digital artery on digital flank were selected based on different wound sizes and injury locations so as to get methods  , and the optimal repair methods are to maintain the primary length and recover the functions of fingers to the maximum extent, especially the favorable appearance and sensation.
Traditional V-Y advancement flap is limited in clinical applications due to its restricted repair size and advancement distance, and fingers and upper limbs need to be fixed with its pedicel flaps of cross fingers and abdomen for 3 weeks and require the second prosthetics to remove the pedicels, which leads to long disease duration, difficult postoperative nursing, swelling appearance and worse sensation.
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The prosthetics did not need the long-length hackly incised free neurovascular bundles, the lateral incision did not surpass the proximal interphalangeal joints, and there was less rate of complications, such as scar contracture. If the wound defect is larger, the bilateral island flap could also be used to extend the repair size.
Tourniquet is applied in the prosthetics to ensure the favorable surgical fields, which should not be excessively used to disperse blood. The flap size should be slightly larger than defect size, and the length of V-shape flap could be prolonged if the repair wound is larger, so as to resolve the difficulty in suturing the donor site.
The free neurovascular bundle on lateral side of flap is anatomized, and minimally invasive technique could be utilized to avoid complete exposure of vascular nerves, so as to prevent the injury or break of vascular verves, while arterial branches should be ligatured or cut off by electro-coagulation to keep flap blood-supply from postoperative bleeding.
Tentative standards of partial functional evaluation of upper arms established by Hand Surgical Association of Chinese Medical Association. Chinese Journal of Practical Hand Surgery ; Repair of soft tissue defect of digital middle and end phalanxes with antidromic island skin flap of dorsal branch of digital artery. Chinese Journal of Practical Hand Surgery ; , 4. Repair of pulp defect with antidromic island flap of digital artery.
Chinese Journal of Reparative and Reconstructive Surgery ;