Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Yao , CHEN Buguo ^△ , DONG Ziqiang , YAN Chengshi , ZHENG Dawei ,  ZHU Hui

Department of Hand Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221004, P.R.China;

Corresponding?author：

ZHU Hui, Email: zhuhuirenci@126.com

Keywords：

Great toe fibular flap; free flap; distal phalanx finger wound

DOI：

10.7507/1002-1892.202009022

Video：

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Objective To investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound.Methods Between June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm.Results All the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good.Conclusion Modified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.

Citation： WU Yao, CHEN Buguo, DONG Ziqiang, YAN Chengshi, ZHENG Dawei, ZHU Hui. Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 206-209. doi: 10.7507/1002-1892.202009022 Copy

1.	Liu C, Liu L, Liu G, et al. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 287.
2.	Toros T, Gurbuz Y, Kelesoglu B, et al. Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger. J Hand Surg (Eur Vol), 2018, 43(10): 1036-1043.
3.	Elliot D, Adani R, Hyun Woo S, et al. Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand Surg (Eur Vol), 2018, 43(10): 1019-1029.
4.	Xuefeng Z, Jian G, Jiayue D, et al. Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects. Med Hypotheses, 2020, 134: 109435. doi: 10.1016/j.mehy.2019.109435.
5.	孫長勝, 李文君, 張玲玲, 等. 修薄的踇趾腓側皮瓣移植修復手指指腹缺損. 中華顯微外科雜志, 2017, 40(5): 464-466.
6.	王進, 趙光勛, 胡灃, 等. 帶部分趾甲的踇趾腓側瓣修復手指末端軟組織合并甲床缺損 12 例. 中華顯微外科雜志, 2019, 42(2): 117-119.
7.	Yuan C, Liu H, Zhang H, et al. Reconstruction of thumb pulp defects using free lateral great toe flaps. J Hand Surg (Am), 2020: S0363-5023(20)30573-6.
8.	熊秉剛, 歐翰杰, 陳健, 等. 拇趾腓側微型組織瓣的解剖及臨床應用. 中國美容整形外科雜志, 2013, 24(2): 95-97.
9.	周健, 楊孝明, 周丕育, 等. 應用游離拇趾腓側皮瓣急診修復拇指指腹創面. 中華整形外科雜志, 2014, 30(6): 464-465.
10.	Sun W, Wang Z, Qiu S, et al. Communicating branch of toe web veins as a venous return pathway in free toe pulp flaps. Plast Reconstr Surg, 2010, 126(5): 268e-269e.
11.	豐波, 鐔云艷, 鄒英財, 等. 趾腓側游離皮瓣修復拇指和手指指腹缺損的療效分析. 中華顯微外科雜志, 2020, 43(4): 392-395.
12.	張興奎, 張桂紅, 吳加明, 等. 應用改良踇趾腓側皮瓣游離修復拇指指腹缺損 12 例. 中華顯微外科雜志, 2011, 34(3): 225-226.
13.	成亮, 陳鏗, 柴益民, 等. 手指末節指掌側淺靜脈的顯微解剖及臨床應用. 中華顯微外科雜志, 2011, 34(2): 131-133, 封3.
14.	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.
15.	糜菁熠, 芮永軍, 壽奎水, 等. 改良踇趾腓側皮瓣修復拇手指指腹缺損. 中華手外科雜志, 2006, 22(1): 32-33.
16.	Zheng X, Zhan Y, Li H, et al. Emergency repair of severe limb injuries with free flow-through chimeric anterolateral thigh perforator flap. Ann Plast Surg, 2019, 83(6): 670-675.
17.	方杰, 張文龍. 伴指固有動脈缺損的手指損傷修復進展. 中華解剖與臨床雜志, 2020, 25(2): 202-207.
18.	Qing L, Wu P, Yu F, et al. Sequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1091-1099.
19.	趙建軍, 謝振軍, 孫華偉, 等. 改良動脈靜脈化在無靜脈吻合甲根部以遠離斷再植中的應用. 中華手外科雜志, 2019, 35(6): 412-414.
20.	馬建安, 趙曉航, 葉紅禹, 等. 指尖離斷再植 125 例臨床體會. 中華手外科雜志, 2018, 34(4): 306-307.

1. Liu C, Liu L, Liu G, et al. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 287.
2. Toros T, Gurbuz Y, Kelesoglu B, et al. Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger. J Hand Surg (Eur Vol), 2018, 43(10): 1036-1043.
3. Elliot D, Adani R, Hyun Woo S, et al. Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand Surg (Eur Vol), 2018, 43(10): 1019-1029.
4. Xuefeng Z, Jian G, Jiayue D, et al. Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects. Med Hypotheses, 2020, 134: 109435. doi: 10.1016/j.mehy.2019.109435.
5. 孫長勝, 李文君, 張玲玲, 等. 修薄的踇趾腓側皮瓣移植修復手指指腹缺損. 中華顯微外科雜志, 2017, 40(5): 464-466.
6. 王進, 趙光勛, 胡灃, 等. 帶部分趾甲的踇趾腓側瓣修復手指末端軟組織合并甲床缺損 12 例. 中華顯微外科雜志, 2019, 42(2): 117-119.
7. Yuan C, Liu H, Zhang H, et al. Reconstruction of thumb pulp defects using free lateral great toe flaps. J Hand Surg (Am), 2020: S0363-5023(20)30573-6.
8. 熊秉剛, 歐翰杰, 陳健, 等. 拇趾腓側微型組織瓣的解剖及臨床應用. 中國美容整形外科雜志, 2013, 24(2): 95-97.
9. 周健, 楊孝明, 周丕育, 等. 應用游離拇趾腓側皮瓣急診修復拇指指腹創面. 中華整形外科雜志, 2014, 30(6): 464-465.
10. Sun W, Wang Z, Qiu S, et al. Communicating branch of toe web veins as a venous return pathway in free toe pulp flaps. Plast Reconstr Surg, 2010, 126(5): 268e-269e.
11. 豐波, 鐔云艷, 鄒英財, 等. 趾腓側游離皮瓣修復拇指和手指指腹缺損的療效分析. 中華顯微外科雜志, 2020, 43(4): 392-395.
12. 張興奎, 張桂紅, 吳加明, 等. 應用改良踇趾腓側皮瓣游離修復拇指指腹缺損 12 例. 中華顯微外科雜志, 2011, 34(3): 225-226.
13. 成亮, 陳鏗, 柴益民, 等. 手指末節指掌側淺靜脈的顯微解剖及臨床應用. 中華顯微外科雜志, 2011, 34(2): 131-133, 封3.
14. 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.
15. 糜菁熠, 芮永軍, 壽奎水, 等. 改良踇趾腓側皮瓣修復拇手指指腹缺損. 中華手外科雜志, 2006, 22(1): 32-33.
16. Zheng X, Zhan Y, Li H, et al. Emergency repair of severe limb injuries with free flow-through chimeric anterolateral thigh perforator flap. Ann Plast Surg, 2019, 83(6): 670-675.
17. 方杰, 張文龍. 伴指固有動脈缺損的手指損傷修復進展. 中華解剖與臨床雜志, 2020, 25(2): 202-207.
18. Qing L, Wu P, Yu F, et al. Sequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1091-1099.
19. 趙建軍, 謝振軍, 孫華偉, 等. 改良動脈靜脈化在無靜脈吻合甲根部以遠離斷再植中的應用. 中華手外科雜志, 2019, 35(6): 412-414.
20. 馬建安, 趙曉航, 葉紅禹, 等. 指尖離斷再植 125 例臨床體會. 中華手外科雜志, 2018, 34(4): 306-307.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein

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