Clinical observation of combined skin flap and abdominal flap for repair of distal finger degloving injury

Abstract

Objective To compare the clinical effect and operation difficulty of the combined skin flap with reversed proper palmar digital arterial dorsal branch island flap and cross-finger flap and the abdominal flap in the treatment of distal finger degloving injury. Methods Inclusion criteria: ①Soft tissue defect far beyond the level of distal interphalangeal joints. ②The inured finger was from second to fifth. ③Single finger injury. ④ Iniury time within 8 h. Exclusive criteria: ①With tendon injury.② Multiple finger injuries. ③Followed-up time within 6 months. Between February, 2009 and September, 2016, 52 patients (52 fingers) with distal finger degloving injury were reviewed, there were 32 males and 20 females, aged from 18 to 60(36.02±11.00) years. The time from injury to operation was 2.5-8.0 (4.81±1.28) h. Affected fingers included index finger in 15 cases, middle finger in 22 cases, ring finger in 10 cases, and little finger in 5 cases. Twenty patients (20 fingers) were treated by combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap(group combined-flap). The cubital skin was grafted onto the donor sites. Thirty-two patients (32 fingers) were treated by abdominal flap (group abdominal-flap). Results The patients were followed-up 6-25 (9.25±3.97) months. The operation time: group combined-flap was 80-130(98.46±8.34) min and group abdominal-flap was 85-125(107.84±8.63)min. There was no significant difference in two groups(P>0.05). Pedicle division time: group combined-flap was 15-24 (16.75±1.74) d and group abdominal-flap was 24-45(28.31±5.12) d. There was a significant difference in two groups(P<0.05). And the pedicle division time in group combined-flap was much shorter than in group abdominal-flap. Flap function at last follow-up, the excellent and good rate of the flap in group combined-flap and group abdominal-flap was 90.00% and 59.38%, respectively. There was a significant difference in two groups (P<0.05), and the flap function in group combined-flap was much better than in group abdominal-flap. Affected finger function at last follow-up, the excellent and good rate of the affected fingers was 95.00% and 71.88%. There was a significant difference in two groups(P<0.05), and the affected finger function in group combined-flap was much better than in group abdominal-flap. Conclusion The combined skin flap with reversed digital arterial dorsal branch island flap and cross-finger flap is a simple and high-survival-rate flap, whose texture, appearance and clinical outcome for repair of distal finger degloving injury are much better than traditional abdominal flap. Key words: Degloved injury; Finger; Dorsal branch, proper palmar digital artery; Island flap; Cross finger skin flap; Combined skin flap; Repair