Repair of thumb defects with modified radial dorsal fasciocutaneous flap of thumb_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Hongjiu ,  XIA Jiang , HU Bin , WANG Haisheng , XU Lei , WANG Yinze

Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical Collage, Wuhu Anhui, 241001, P.R.China;

Corresponding?author：

XIA Jiang, Email: woshilkxiaoqiang@163.com

Keywords：

Thumb; fasciocutaneous flap; tissue defect; repair

DOI：

10.7507/1002-1892.201703053

Video：

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ObjectiveTo investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness.MethodsBetween June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured.ResultsAll flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases.ConclusionModified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.

Citation： QIN Hongjiu, XIA Jiang, HU Bin, WANG Haisheng, XU Lei, WANG Yinze. Repair of thumb defects with modified radial dorsal fasciocutaneous flap of thumb. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 841-844. doi: 10.7507/1002-1892.201703053 Copy

1.	Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg, 2008, 122(3): 105e-117e.
2.	Hrabowski M, Kloeters O, Germann G. Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique. J Hand Surg (Am), 2010, 35(4): 659-662.
3.	毛莉穎, 黃東, 江奕恒, 等. 手部不同遠端蒂皮瓣靜脈回流障礙的原因分析. 中國臨床解剖學雜志, 2013, 31(4): 484-486.
4.	張世民, 袁鋒, 俞光榮, 等. 遠端蒂拇指背尺側皮瓣修復指端缺損及靜脈回流. 中國臨床解剖學雜志, 2005, 23(2): 206-208.
5.	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.
6.	Bao QY, Xiao CW, Peng F, et al. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg, 2014, 30(1): 15-20.
7.	Sun YC, Gong YP, Chen QZ. A reverse dorsoradial pedicled flap from the thumb for a soft tissue defect in the finger. J Hand Surg (Eur Vol), 2015, 40(9): 1000-1001.
8.	Lazzeri D, Huemer GM, Nicoli F, et al. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: asystematic review. Arch Plast Surg, 2013, 40(1): 44-50.
9.	代杰志, 柴益民. 遠端蒂隱神經營養血管皮瓣研究進展. 國際骨科學雜志, 2013, 34(1): 53-54.
10.	Checcucci G, Galeano M, Zucchini M, et al. Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb. Microsurgery, 2014, 34(4): 283-286.
11.	Ramírez AR, Gonzalez SM. Arteries of the thumb:, description of anatomical variations and review of the literature. Plast Reconstr Surg, 2012, 129(3): 468e-476e.
12.	Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg, 2006, 117(3): 920-926.
13.	Sun YC, Chen QZ, Chen J, et al. Reverse Dorsoradial Flaps for Thumb Coverage Show Increased Sensory Recovery with Smaller Flap Sizes. J Reconstr Microsurg, 2015, 31(6): 426-433.
14.	梁成, 謝昀, 鄭和平, 等. 穿支蒂足背外側皮神經淺靜脈營養血管皮瓣的解剖基礎. 中國臨床解剖學雜志, 2014, 32(4): 377-380.
15.	張發惠, 謝其揚, 鄭和平, 等. 腓腸神經-小隱靜脈營養血管遠端蒂皮瓣動脈穿支的應用解剖. 中國修復重建外科雜志, 2005, 19(7): 501-504.
16.	張世民, 劉大雄, 張連生, 等. 遠端蒂皮瓣的血液循環特征及臨床意義. 中國臨床解剖學雜志, 1998, 16(2): 103-106.
17.	Akita S, Mitsukawa N, Rikihisa N, et al. Reconstruction of the great toe using a pedicled medial plantar flap with anterograde venous drainage. Microsurgery, 2014, 34(5): 398-403.
18.	查選平, 周赤龍, 金鐘鳴, 等. 經皮縫扎阻斷小隱靜脈回流降低遠端蒂腓腸神經營養血管皮瓣靜脈瘀血的臨床研究. 中華損傷與修復雜志(電子版), 2009, 4(3): 16-19.

1. Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg, 2008, 122(3): 105e-117e.
2. Hrabowski M, Kloeters O, Germann G. Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique. J Hand Surg (Am), 2010, 35(4): 659-662.
3. 毛莉穎, 黃東, 江奕恒, 等. 手部不同遠端蒂皮瓣靜脈回流障礙的原因分析. 中國臨床解剖學雜志, 2013, 31(4): 484-486.
4. 張世民, 袁鋒, 俞光榮, 等. 遠端蒂拇指背尺側皮瓣修復指端缺損及靜脈回流. 中國臨床解剖學雜志, 2005, 23(2): 206-208.
5. 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.
6. Bao QY, Xiao CW, Peng F, et al. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg, 2014, 30(1): 15-20.
7. Sun YC, Gong YP, Chen QZ. A reverse dorsoradial pedicled flap from the thumb for a soft tissue defect in the finger. J Hand Surg (Eur Vol), 2015, 40(9): 1000-1001.
8. Lazzeri D, Huemer GM, Nicoli F, et al. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: asystematic review. Arch Plast Surg, 2013, 40(1): 44-50.
9. 代杰志, 柴益民. 遠端蒂隱神經營養血管皮瓣研究進展. 國際骨科學雜志, 2013, 34(1): 53-54.
10. Checcucci G, Galeano M, Zucchini M, et al. Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb. Microsurgery, 2014, 34(4): 283-286.
11. Ramírez AR, Gonzalez SM. Arteries of the thumb:, description of anatomical variations and review of the literature. Plast Reconstr Surg, 2012, 129(3): 468e-476e.
12. Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg, 2006, 117(3): 920-926.
13. Sun YC, Chen QZ, Chen J, et al. Reverse Dorsoradial Flaps for Thumb Coverage Show Increased Sensory Recovery with Smaller Flap Sizes. J Reconstr Microsurg, 2015, 31(6): 426-433.
14. 梁成, 謝昀, 鄭和平, 等. 穿支蒂足背外側皮神經淺靜脈營養血管皮瓣的解剖基礎. 中國臨床解剖學雜志, 2014, 32(4): 377-380.
15. 張發惠, 謝其揚, 鄭和平, 等. 腓腸神經-小隱靜脈營養血管遠端蒂皮瓣動脈穿支的應用解剖. 中國修復重建外科雜志, 2005, 19(7): 501-504.
16. 張世民, 劉大雄, 張連生, 等. 遠端蒂皮瓣的血液循環特征及臨床意義. 中國臨床解剖學雜志, 1998, 16(2): 103-106.
17. Akita S, Mitsukawa N, Rikihisa N, et al. Reconstruction of the great toe using a pedicled medial plantar flap with anterograde venous drainage. Microsurgery, 2014, 34(5): 398-403.
18. 查選平, 周赤龍, 金鐘鳴, 等. 經皮縫扎阻斷小隱靜脈回流降低遠端蒂腓腸神經營養血管皮瓣靜脈瘀血的臨床研究. 中華損傷與修復雜志(電子版), 2009, 4(3): 16-19.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of thumb defects with modified radial dorsal fasciocutaneous flap of thumb

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