Clinical application of web-space artery perforator and dorsal branch of the proper digital artery network flap for repair of finger pulp defects

Abstract

Objective To evaluate the clinical efficacy of web-space artery perforator and dorsal branch of the proper digital artery network flap in the treatment of finger pulp defects. Methods From January 2015 to May 2017, 30 cases (36 fingers) of finger pulp defects were treated by web-space artery perforator and dorsal branch of the proper digital artery network flap. The nerve stump and dorsal digital nerve were sutured to reconstruct the flap sensation. The area of finger pulp defects ranged from 1.1 cm×0.8 cm to 2.3 cm×4.0 cm. The donor site was sutured directly or covered with skin graft. Results After the operation, tension vesicles appeared at the distal end of the flap in 3 cases which achieved secondary healing after dressing changes and flaps edge bleeding. Partial skin flap necrosis and scab occurred in 1 case that achieved healing after the decrustation. The rest of the flaps achieved primary healing. All the patients were follow-up for 3 to 24 months with an average of 16.8 months. The texture of skin flap was soft with satisfactory appearance. The skin flap recovered pain and temperature sensation 2 months after operation. And 3 months after the operation, the tactile sensation was restored. The two-point discrimination was recovered at 6 months after operation, with an average of 7.5 mm and an average of 6.2 mm at 12 months postoperatively. The total active movement (TAM) achieved 105° to 230° with an average of 204.6°. The results were graded as excellent in 22 fingers, good in 11 fingers, fair in 2 fingers, and poor in 1 finger with an excellent and good rate of 91.7%. Conclusion Compared with the traditional digital artery island flap, the island flap of web-space artery perforator and dorsal branch of the proper digital artery is used to repair the defects of the finger pulp, lengthening the length of the pedicle and enlarging the indication of the operation. The operation is simple and safe. It is a better method to repair the defect of the finger pulp. Key words: Finger injuries; Surgical flaps; Web-space artery perforator; Dorsal branch of the proper digital artery