REPAIR OF COMPOSITE TISSUE DEFECTS OF DORSAL THUMB INCLUDING INTERPHALANGEAL JOINT BY TRANSPLANTATION OF MODIFIED HALLUX TOE-NAIL COMPOSITE TISSUE FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUJinwei , HEZaopeng ,  LIWei , ZHOUCongzhen , ZHENGYudong , ZENGDifan , LIUDongbo

Department of Hand and Foot Surgery, Affiliated Lecong Hospital of Guangzhou Medical University, Foshan Guangdong, 528315, P. R. China;

Corresponding?author：

LIWei, Email: leclw@126.com

Keywords：

Hallux toe-nail composite tissue flap; Thumb; Composite tissue defect; Wound repair

DOI：

10.7507/1002-1892.20150303

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore a new improved technique and its effectiveness to repair dorsal thumb composite tissue defects including interphalangeal joint by transplantation of modified hallux toe-nail composite tissue flap. Methods The hallux toe-nail composite tissue flap carrying distal half hallux proximal phalanx, extensor hallucis longus, and interphalangeal joint capsule were designed and applied to repair the dorsal skin, nails, and interphalangeal joint defect of thumb in 14 cases between January 2007 and June 2013. They were all males, aged from 19 to 52 years (mean, 30 years). The time from injury to hospital was 0.5-2.0 hours (mean, 1.2 hours). The area of the thumb nail and dorsal skin defects ranged from 2.5 cm×1.5 cm to 5.0 cm×2.5 cm. The dorsal interphalangeal joint had different degrees of bone defect, with residual bone and joint capsule at the palm side. The length of bone defect ranged from 2.5 to 4.0 cm (mean, 3.4 cm). The hallux nail flap size ranged from 3.0 cm×2.0 cm to 6.0 cm×3.0 cm. The donor sites were repaired by skin grafting in 5 cases, and retrograde second dorsal metatarsal artery island flap in 9 cases. Results After operation, arterial crisis occurred in 1 case and the flap survived after relieving pressure; the other flaps survived, and wounds healed by first intention. Liquefaction necrosis of the skin grafting at donor site occurred in 3 cases, and the other skin grafting and all retrograde second dorsal metatarsal artery island flaps survived. The follow-up ranged from 9 months to 3 years and 6 months (mean, 23 months). The secondary plastic operation was performed in 4 cases at 6 months after operation because of slightly bulky composite tissue flaps. The other composite tissue flaps had good appearance, color, and texture. The growth of the nail was good in 12 cases, and slightly thickened in 2 cases. At last follow-up, X-ray examination showed that bone graft and proximal phalanx of the thumb had good bone healing in 12 cases. Good bone healing was obtained at the donor site. According to the Hand Surgical Branch of Chinese Medical Association standard for thumb and finger reconstruction function, the results were excellent in 12 cases and good in 2 cases, and the excellent and good rate was 100%. No pain at donor site was observed, with normal gait. Conclusion Transplantation of modified hallux toe-nail composite tissue flap to repair dorsal thumb composite tissue defects including interphalangeal joint can effectively improve the appearance and function of the impaired thumb.

Citation： LIUJinwei, HEZaopeng, LIWei, ZHOUCongzhen, ZHENGYudong, ZENGDifan, LIUDongbo. REPAIR OF COMPOSITE TISSUE DEFECTS OF DORSAL THUMB INCLUDING INTERPHALANGEAL JOINT BY TRANSPLANTATION OF MODIFIED HALLUX TOE-NAIL COMPOSITE TISSUE FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1415-1418. doi: 10.7507/1002-1892.20150303 Copy

1.	陳啟康, 李衛, 黃繼輝, 等. 木工機械致手外傷的流行病學特點. 中華手外科雜志, 2003, 19(2):99-100.
2.	李衛, 劉金偉, 何藻鵬, 等. 拆分第二足趾修復兩個相鄰掌指關節背側復合組織缺損. 中華顯微外科雜志, 2012, 35(6):460-463.
3.	劉金偉, 何藻鵬, 李衛, 等. 改良第2跖趾關節移植修復拇手指掌指關節背側缺損. 實用手外科雜志, 2014, 28(4):366-368, 465.
4.	李衛, 劉金偉, 何藻鵬, 等. 改良第二跖趾關節移植修復木工機械致掌指關節背側缺損. 中華手外科雜志, 2013, 29(3):167-169.
5.	王東, 凌彤, 譚成祥, 等. 第二跖背動脈逆行島狀皮瓣修復甲瓣切除后的創面. 中華手外科雜志, 2000, 16(1):40-42.
6.	蔣協遠, 王大偉. 骨科臨床療效評價標準. 北京:人民衛生出版社, 2005:16-17.
7.	袁光海, 程國良, 方光榮, 等. 半趾甲瓣移植修復手指末節半側缺損. 中華顯微外科雜志, 2002, 25(3):168-169.
8.	李木衛, 陳飛, 馬立峰, 等. 游離腓動脈穿支皮瓣修復足部供區創面的療效. 中國修復重建外科雜志, 2014, 28(3):389-390.
9.	St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg (Am), 1997, 22(5):913-917.
10.	王欣, 章偉文, 陳宏, 等. 部分甲瓣移植修復拇指末節半側缺損. 中華手外科雜志, 2006, 22(6):360-361.
11.	芮永軍, 施海峰, 邱揚, 等. 不同構制的甲瓣修復手指套脫傷. 中華手外科雜志, 2007, 23(6):349-351.
12.	楊慶達, 張智釗, 盧家靈, 等. 改良第一趾蹼皮瓣游離移植術后供區創面的修復. 中國修復重建外科雜志, 2013, 27(10):1279-1280.
13.	Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg, 2005, 21(4):225-229.
14.	申立林, 藺翠霞, 孫雪生, 等. 跗外側動脈穿支皮瓣修復拇甲瓣供區創面的臨床應用. 齊魯醫學雜志, 2015, 30(1):42-43.
15.	魏在榮, 孫廣峰, 王達利, 等. 跖背動脈遠端穿支蒂鏈型供血皮瓣修復足遠端創面. 南方醫科大學學報, 2010, 30(8):1835-1837.
16.	曲連軍, 張成進, 劉學勝, 等. 用帶遠側1/2末節趾骨的甲瓣修復拇指脫套傷. 中華顯微外科雜志, 2007, 30(5):377-378.

1. 陳啟康, 李衛, 黃繼輝, 等. 木工機械致手外傷的流行病學特點. 中華手外科雜志, 2003, 19(2):99-100.
2. 李衛, 劉金偉, 何藻鵬, 等. 拆分第二足趾修復兩個相鄰掌指關節背側復合組織缺損. 中華顯微外科雜志, 2012, 35(6):460-463.
3. 劉金偉, 何藻鵬, 李衛, 等. 改良第2跖趾關節移植修復拇手指掌指關節背側缺損. 實用手外科雜志, 2014, 28(4):366-368, 465.
4. 李衛, 劉金偉, 何藻鵬, 等. 改良第二跖趾關節移植修復木工機械致掌指關節背側缺損. 中華手外科雜志, 2013, 29(3):167-169.
5. 王東, 凌彤, 譚成祥, 等. 第二跖背動脈逆行島狀皮瓣修復甲瓣切除后的創面. 中華手外科雜志, 2000, 16(1):40-42.
6. 蔣協遠, 王大偉. 骨科臨床療效評價標準. 北京:人民衛生出版社, 2005:16-17.
7. 袁光海, 程國良, 方光榮, 等. 半趾甲瓣移植修復手指末節半側缺損. 中華顯微外科雜志, 2002, 25(3):168-169.
8. 李木衛, 陳飛, 馬立峰, 等. 游離腓動脈穿支皮瓣修復足部供區創面的療效. 中國修復重建外科雜志, 2014, 28(3):389-390.
9. St-Laurent JY, Lanzetta M. Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap. J Hand Surg (Am), 1997, 22(5):913-917.
10. 王欣, 章偉文, 陳宏, 等. 部分甲瓣移植修復拇指末節半側缺損. 中華手外科雜志, 2006, 22(6):360-361.
11. 芮永軍, 施海峰, 邱揚, 等. 不同構制的甲瓣修復手指套脫傷. 中華手外科雜志, 2007, 23(6):349-351.
12. 楊慶達, 張智釗, 盧家靈, 等. 改良第一趾蹼皮瓣游離移植術后供區創面的修復. 中國修復重建外科雜志, 2013, 27(10):1279-1280.
13. Kawamura K, Yajima H, Kobata Y, et al. Coverage of big toe defects after wrap-around flap transfer with a free soleus perforator flap. J Reconstr Microsurg, 2005, 21(4):225-229.
14. 申立林, 藺翠霞, 孫雪生, 等. 跗外側動脈穿支皮瓣修復拇甲瓣供區創面的臨床應用. 齊魯醫學雜志, 2015, 30(1):42-43.
15. 魏在榮, 孫廣峰, 王達利, 等. 跖背動脈遠端穿支蒂鏈型供血皮瓣修復足遠端創面. 南方醫科大學學報, 2010, 30(8):1835-1837.
16. 曲連軍, 張成進, 劉學勝, 等. 用帶遠側1/2末節趾骨的甲瓣修復拇指脫套傷. 中華顯微外科雜志, 2007, 30(5):377-378.

Chinese Journal of Reparative and Reconstructive Surgery

REPAIR OF COMPOSITE TISSUE DEFECTS OF DORSAL THUMB INCLUDING INTERPHALANGEAL JOINT BY TRANSPLANTATION OF MODIFIED HALLUX TOE-NAIL COMPOSITE TISSUE FLAP

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content