Application of groin flap combined with medial plantar artery perforator flap for degree <b>Ⅲ</b>-<b>Ⅳ</b> defects of multiple fingers_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Xingming , TANG Lin , LIU Anming , ZHOU Xin , CHEN Xiaojun ,  ZOU Yonggen

Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

ZOU Yonggen, Email: Yonggenzou1975@163.com

Keywords：

Groin flap; medial plantar artery perforator flap; finger defect; multiple fingers reconstruction

DOI：

10.7507/1002-1892.202204008

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Objective To investigate the effectiveness of groin flap combined with medial plantar artery perforator flap (MPAP) for degree Ⅲ-Ⅳ defects of multiple fingers. Methods Between January 2018 and June 2019, 12 patients with degree Ⅲ-Ⅳ defects of multiple fingers caused by crushing were admitted. There were 9 males and 3 females with a median age of 29 years (range, 16-42 years). The mean interval between the injury and admission was 3 hours (range, 1-9 hours). The injured fingers of 7 cases were index and middle fingers, 4 cases were middle and ring fingers, and 1 case was index, middle, and ring fingers. All fingers were taken thorough debridement and covered by the vacuum sealing drainage device during the emergency operation. The mean interval between the debridement and flap repairing was 18 hours (range, 12-36 hours). During the first-stage operation, the iliac bone graft was used to reconstruct bone frame, and the proximal interphalangeal (PIP) joint from the foot was transferred as the digital PIP joint, then the thin groin flap and MPAP were tailored to cover the dorsal and palmar defects, respectively. The size of the groin flap was 7.0 cm×4.5 cm-14.0 cm×9.0 cm, and the size of the MPAP was 8.0 cm×4.5 cm-14.0 cm×6.5 cm. The abdominal donor site was directly sutured, and the foot was repaired with full-thickness skin grafting. The flaps were separated into the finger shape at the second-stage. Results All the flaps survived, and the wounds healed by first intention; the incisions in the donor site healed by first intention, and the skin grafts survived completely. All patients were followed up 12-18 months (mean, 16 months). At last follow-up, the injured finger was similar to the contralateral one in terms of texture, appearance, and color. The mean two-point discrimination was 8 mm (range, 6-10 mm), and the sensate level recovered to the S₃-S₄. According to the Michigan Hand Outcomes Questionnaire (MHQ), the reconstructed hand function was excellent in 8 cases and good in 4 cases. There was no complication in the donor sites. Conclusion The degree Ⅲ-Ⅳ defects of multiple fingers were repaired by the groin flap and MPAP, and the reconstructed fingers can perform good texture and motion with being sensate, with less sacrifice on the foot.

Citation： LIU Xingming, TANG Lin, LIU Anming, ZHOU Xin, CHEN Xiaojun, ZOU Yonggen. Application of groin flap combined with medial plantar artery perforator flap for degree Ⅲ-Ⅳ defects of multiple fingers. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(8): 1026-1031. doi: 10.7507/1002-1892.202204008 Copy

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2.	程國良. 足趾移植再造拇指和手指外形的修飾理念. 中華顯微外科雜志, 2009, 32(2): 92-94.
3.	王增濤. 拇指及手指的全形再造. 中華顯微外科雜志, 2020, 43(5): 424-434.
4.	王濤, 顧玉東. 足趾移植重建拇、手指的歷史與現狀. 中華手外科雜志, 2021, 37(3): 215-218.
5.	Cheng G, Fang G, Hou S, et al. Aesthetic reconstruction of thumb or finger partial defect with trimmed toe-flap transfer. Microsurgery, 2007, 27(2): 74-83.
6.	Shen XF, Mi JY, Xue MY, et al. Modified great toe wraparound flap with preservation of plantar triangular flap for reconstruction of degloving injuries of the thumb and fingers: long-term follow-up. Plast Reconstr Surg, 2016, 138(1): 155-163.
7.	Rui Y, Mi J, Shi H, et al. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers. Microsurgery, 2010, 30(6): 449-456.
8.	Koshima I, Soeda S, Murashita T. Extended wrap-around flap for reconstruction of the finger with recurrent arteriovenous malformation. Plast Reconstr Surg, 1993, 91(6): 1140-1144.
9.	Tsai TM, Falconer D. Modified great toe wrap for thumb reconstruction. Microsurgery, 1986, 7(4): 193-198.
10.	Troisi L, Berner JE, West EV, et al. Medial plantar flap for hand reconstruction: A systematic literature review and its application for post-sarcoma excision. Ann Plast Surg, 2019, 82(3): 337-343.
11.	Yu Z, Huang Y. Sixty-four cases of thumb and finger reconstruction using transplantation of the big toe skin-nail flap combined with the second toe or the second and third toes. Plast Reconstr Surg, 2000, 106(2): 335-341.
12.	Sun W, Chen C, Wang Z, et al. Full-length finger reconstruction for proximal amputation with expanded wraparound great toe flap and vascularized second toe joint. Ann Plast Surg, 2016, 77(5): 539-546.
13.	周健輝, 周麗杏, 冷樹立, 等. 踇甲皮瓣聯合足底內側皮瓣再造Ⅱ和Ⅲ度缺損手指. 中華顯微外科雜志, 2018, 41(5): 492-494.
14.	黃威, 許良, 程保國, 等. 3D打印技術在拇指及手指全形再造中的應用. 中華顯微外科雜志, 2020, 43(5): 459-463.
15.	郝麗文, 陳超, 王增濤. 骨延長技術在手指缺損全形再造中的應用效果觀察. 山東醫藥, 2018, 58(44): 58-60.
16.	Tang L, Zhou X, Zou YG. One-stage coverage of multi-digital pulp defects with sensate flaps from the foot. Injury, 2022, 53(4): 1557-1561.
17.	唐林, 周鑫, 黃宇, 等. 踇甲皮瓣聯合足底內側動脈穿支皮瓣瓦合修復長手指脫套傷. 中國修復重建外科雜志, 2022, 36(4): 456-460.

1. 顧玉東, 王澍寰, 侍德. 手外科手術學. 2 版. 上海: 復旦大學出版社有限公司, 2010: 772-775.
2. 程國良. 足趾移植再造拇指和手指外形的修飾理念. 中華顯微外科雜志, 2009, 32(2): 92-94.
3. 王增濤. 拇指及手指的全形再造. 中華顯微外科雜志, 2020, 43(5): 424-434.
4. 王濤, 顧玉東. 足趾移植重建拇、手指的歷史與現狀. 中華手外科雜志, 2021, 37(3): 215-218.
5. Cheng G, Fang G, Hou S, et al. Aesthetic reconstruction of thumb or finger partial defect with trimmed toe-flap transfer. Microsurgery, 2007, 27(2): 74-83.
6. Shen XF, Mi JY, Xue MY, et al. Modified great toe wraparound flap with preservation of plantar triangular flap for reconstruction of degloving injuries of the thumb and fingers: long-term follow-up. Plast Reconstr Surg, 2016, 138(1): 155-163.
7. Rui Y, Mi J, Shi H, et al. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers. Microsurgery, 2010, 30(6): 449-456.
8. Koshima I, Soeda S, Murashita T. Extended wrap-around flap for reconstruction of the finger with recurrent arteriovenous malformation. Plast Reconstr Surg, 1993, 91(6): 1140-1144.
9. Tsai TM, Falconer D. Modified great toe wrap for thumb reconstruction. Microsurgery, 1986, 7(4): 193-198.
10. Troisi L, Berner JE, West EV, et al. Medial plantar flap for hand reconstruction: A systematic literature review and its application for post-sarcoma excision. Ann Plast Surg, 2019, 82(3): 337-343.
11. Yu Z, Huang Y. Sixty-four cases of thumb and finger reconstruction using transplantation of the big toe skin-nail flap combined with the second toe or the second and third toes. Plast Reconstr Surg, 2000, 106(2): 335-341.
12. Sun W, Chen C, Wang Z, et al. Full-length finger reconstruction for proximal amputation with expanded wraparound great toe flap and vascularized second toe joint. Ann Plast Surg, 2016, 77(5): 539-546.
13. 周健輝, 周麗杏, 冷樹立, 等. 踇甲皮瓣聯合足底內側皮瓣再造Ⅱ和Ⅲ度缺損手指. 中華顯微外科雜志, 2018, 41(5): 492-494.
14. 黃威, 許良, 程保國, 等. 3D打印技術在拇指及手指全形再造中的應用. 中華顯微外科雜志, 2020, 43(5): 459-463.
15. 郝麗文, 陳超, 王增濤. 骨延長技術在手指缺損全形再造中的應用效果觀察. 山東醫藥, 2018, 58(44): 58-60.
16. Tang L, Zhou X, Zou YG. One-stage coverage of multi-digital pulp defects with sensate flaps from the foot. Injury, 2022, 53(4): 1557-1561.
17. 唐林, 周鑫, 黃宇, 等. 踇甲皮瓣聯合足底內側動脈穿支皮瓣瓦合修復長手指脫套傷. 中國修復重建外科雜志, 2022, 36(4): 456-460.

Chinese Journal of Reparative and Reconstructive Surgery

Application of groin flap combined with medial plantar artery perforator flap for degree Ⅲ-Ⅳ defects of multiple fingers

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