Repair of distal finger degloving injury with homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap

Abstract

Objective To explore the surgical procedure and the clinical results of repairing distal finger degloving injury with homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap. Methods From April 2012 to August 2016, 20 patients with degloving injury of the distal finger caused by machine were treated. There were 16 males and 4 females with age ranging from 18 to 59 years (mean, 31 years). The time from injury to operation was 1 to 5 hours (mean, 2.5 hours). Affected fingers included index finger in 8 cases, middle finger in 6 cases, ring finger in 4 cases, little finger in 2 cases. The totally degloving range was 1/2 distal finger in 3 cases, 2/3 in 12 cases, 3/4 in 5 cases. The defect area ranged from 3.0 cm×2.0 cm to 5.5 cm×3.8 cm, with mild to severe pollution, tendons and phalanx bone exposure. No tendon insertion rupture was seen. The homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap were applied to repair the wound. The area of homodigital flap based on the dorsal branch of the digital artery ranged from 2.0 cm×1.5 cm to 2.6 cm×2.2 cm, and of adjacent finger island flap ranged from 2.5 cm×2.0 cm to 3.5 cm×2.5 cm. The donor sites were repaired with skin grafts. Results Postoperatively flap blister occurred in 5 cases and vascular crisis occurred in 1 case, which survived completely after symptomatic treatment. The rest of the flaps survived uneventfully. Primary healing was achieved in 18 cases, secondary healing in 2 cases. The postoperative follow-up time ranged from 3 to 20 months with an average of 10.6 months. The flaps had well-stacked shape with soft texture and no tenderness in fingertip. According to the Total Active Movement (TAM) system evaluation standard, the finger function was assessed excellent in 17 cases, good in 2 cases and fair in 1 case. Conclusion The combination of homodigital flap based on the dorsal branch of the digital artery and adjacent finger island flap is an easy, useful and reliable technique for reconstruction of distal finger degloving injury with satisfactory results. Key words: Finger injuries; Surgical flaps; Finger distal degloving injury; Wound reconstruction