RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANGBin ¹ , JIASong ¹ , LUAidong ² , HAORuizheng ¹ , HUOYongxin ¹ , FEIXiaoxuan ¹ , PANGHaitao ¹

1. Department of Hand Surgery, the Second Hospital of Tangshan (Affiliated Orthopedic Hospital of Hebei United University), Tangshan Hebei, 063000, P.R.China;
2. Department of Ophthalmology, Kailuan General Hospital;

Corresponding?author：

WANGBin, Email: wbladyp3@163.com

Keywords：

Free second toe dorsal flap; Middle or ring finger island flap; Thumb; Degloving injury

DOI：

10.7507/1002-1892.20160284

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs. Methods Between August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years (mean, 32 years). The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts. Results All of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years (mean, 23 months). The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S₃, and the mean two-point discrimination of the pulp was 6 mm (range, 4-7 mm). According to total active movement (TAM) system, the function of the thumbs was excellent in 5 cases and good in 1 case. Conclusion A combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a degloved thumb.

Citation： WANGBin, JIASong, LUAidong, HAORuizheng, HUOYongxin, FEIXiaoxuan, PANGHaitao. RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1383-1386. doi: 10.7507/1002-1892.20160284 Copy

1.	郭旭, 董華祥, 石濤, 等.真皮下血管網皮瓣修復手指脫套傷38例.中國修復重建外科雜志, 2007, 21(1): 94-95.
2.	劉道功, 張浩, 簡玉洛, 等.胸臍游離皮瓣在四肢軟組織缺損修復中的應用.中華顯微外科雜志, 2004, 27(4): 297-298.
3.	許亞軍, 壽奎水, 芮永軍, 等. 600例股前外側皮瓣移植術的臨床應用經驗.中華整形外科雜志, 2005, 21(6): 418-420.
4.	王海文, 侯瑞興, 馮連銀, 等.帶足背皮瓣的第二趾甲皮瓣修復全指皮膚脫套傷.中華手外科雜志, 2003, 19(4): 212.
5.	Wang B, Zhang X, Jiang W, et al. Reconstruction of distally degloved fingers with a cross-finger flap and a composite-free flap from the dorsum of the second toe. J Hand Surg (Am), 2011, 37(2): 303-309.e1-4.
6.	芮永軍, 施海峰, 邱揚, 等.部分甲瓣和第二趾腹皮瓣聯合修復指脫套傷. 2005, 28(4): 295-296.
7.	王斌, 蔣文平, 李文龍, 等.游離第二足趾背甲皮瓣聯合趾腓側皮瓣游離移植修復單指脫套傷.中華顯微外科雜志, 2012, 35(6): 444-446.
8.	Adani R, Corain M, Tarallo L, et al. Alternative method for thumb reconstruction. Combination of 2 techniques: metacarpal lengthening and mini wraparound transfer. J Hand Surg (Am), 2013, 38(5): 1006-1011.
9.	ünal MB, Cansü E, Parmaksizo?lu F. Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg (Am), 2011, 36(4): 661-664.
10.	焦偉, 王斌, 馬鐵鵬.指骨延長與關節成形修復再植手指短縮.中華手外科雜志, 2013, 29(6): 379-381.
11.	廖觀祥.雙側姆趾皮瓣瓦合修復全拇指皮膚脫套傷的可行性研究.蘇州:蘇州大學, 2014.
12.	王斌.手部組織缺損的修復.北京:人民軍醫出版社, 2008: 241-254.
13.	潘達德, 顧玉東, 侍德, 等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志, 2000, 16(3): 130-135.
14.	王澍寰.手外科學. 3版.北京:人民衛生出版社, 2011: 486-487.
15.	廖觀祥, 巨積輝, 劉新益, 等.雙側趾皮瓣瓦合修復拇指套脫傷可行性的初步探索.中國臨床解剖學雜志, 2013, 31(6): 650-654.
16.	顧玉東.手的修復與再造.上海:上海醫科大學出版社, 1995: 143.
17.	許亞軍, 陳政, 姚群, 等.改良中環指島狀皮瓣加髂骨植骨再造拇指.實用手外科雜志, 2009, 23(2): 72-73.
18.	黃燮青, 章開衡, 沈華.甲皮瓣供區創面的處理.中國修復重建外科雜志, 2001, 15(6): 338-340.
19.	成紅兵, 侍德, 張烽, 等.中環指雙島狀皮瓣重建拇指的遠期療效.中華手外科雜志, 1997, 13(2): 96-99.

1. 郭旭, 董華祥, 石濤, 等.真皮下血管網皮瓣修復手指脫套傷38例.中國修復重建外科雜志, 2007, 21(1): 94-95.
2. 劉道功, 張浩, 簡玉洛, 等.胸臍游離皮瓣在四肢軟組織缺損修復中的應用.中華顯微外科雜志, 2004, 27(4): 297-298.
3. 許亞軍, 壽奎水, 芮永軍, 等. 600例股前外側皮瓣移植術的臨床應用經驗.中華整形外科雜志, 2005, 21(6): 418-420.
4. 王海文, 侯瑞興, 馮連銀, 等.帶足背皮瓣的第二趾甲皮瓣修復全指皮膚脫套傷.中華手外科雜志, 2003, 19(4): 212.
5. Wang B, Zhang X, Jiang W, et al. Reconstruction of distally degloved fingers with a cross-finger flap and a composite-free flap from the dorsum of the second toe. J Hand Surg (Am), 2011, 37(2): 303-309.e1-4.
6. 芮永軍, 施海峰, 邱揚, 等.部分甲瓣和第二趾腹皮瓣聯合修復指脫套傷. 2005, 28(4): 295-296.
7. 王斌, 蔣文平, 李文龍, 等.游離第二足趾背甲皮瓣聯合趾腓側皮瓣游離移植修復單指脫套傷.中華顯微外科雜志, 2012, 35(6): 444-446.
8. Adani R, Corain M, Tarallo L, et al. Alternative method for thumb reconstruction. Combination of 2 techniques: metacarpal lengthening and mini wraparound transfer. J Hand Surg (Am), 2013, 38(5): 1006-1011.
9. ünal MB, Cansü E, Parmaksizo?lu F. Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg (Am), 2011, 36(4): 661-664.
10. 焦偉, 王斌, 馬鐵鵬.指骨延長與關節成形修復再植手指短縮.中華手外科雜志, 2013, 29(6): 379-381.
11. 廖觀祥.雙側姆趾皮瓣瓦合修復全拇指皮膚脫套傷的可行性研究.蘇州:蘇州大學, 2014.
12. 王斌.手部組織缺損的修復.北京:人民軍醫出版社, 2008: 241-254.
13. 潘達德, 顧玉東, 侍德, 等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志, 2000, 16(3): 130-135.
14. 王澍寰.手外科學. 3版.北京:人民衛生出版社, 2011: 486-487.
15. 廖觀祥, 巨積輝, 劉新益, 等.雙側趾皮瓣瓦合修復拇指套脫傷可行性的初步探索.中國臨床解剖學雜志, 2013, 31(6): 650-654.
16. 顧玉東.手的修復與再造.上海:上海醫科大學出版社, 1995: 143.
17. 許亞軍, 陳政, 姚群, 等.改良中環指島狀皮瓣加髂骨植骨再造拇指.實用手外科雜志, 2009, 23(2): 72-73.
18. 黃燮青, 章開衡, 沈華.甲皮瓣供區創面的處理.中國修復重建外科雜志, 2001, 15(6): 338-340.
19. 成紅兵, 侍德, 張烽, 等.中環指雙島狀皮瓣重建拇指的遠期療效.中華手外科雜志, 1997, 13(2): 96-99.

Chinese Journal of Reparative and Reconstructive Surgery

RECONSTRUCTION OF DEGLOVED THUMBS WITH FREE SECOND TOE DORSAL FLAP COMBINED WITH MIDDLE OR RING FINGER ISLAND FLAP

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content