Repair of distal thumb degloving injury using combination of reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap

Ruizheng Hao,Huanyou Yang,Bin Wang,Hui Wang,Yongxin Huo

doi:10.1186/s13018-020-01940-y

Ruizheng Hao, Huanyou Yang + Show 3 more

Open Access

https://doi.org/10.1186/s13018-020-01940-y

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Abstract

BackgroundTo examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury.MethodsTwelve patients with mechanical distal thumb degloving injuries were treated between February 2017 and August 2019. A combination of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap were used. Semmes–Weinstein (SW) monofilament and static two-point discrimination (S-2PD) tests, active range-of-motion (ROM) of the joints, cold intolerance, visual analog scale (VAS) score patient complications, and patient satisfaction were sequentially evaluated.ResultsTwo cases with postoperative flap blisters were treated at time of dressing changes up to successful scab formation. One case with postoperative arterial crisis of finger arterial dorsal branch vessel was successfully released in the pedicle. Ten cases healed by first intention and 2 cases by secondary intention. Twelve patients received follow-up examinations between 3 and 20 months (average 13 months) post-treatment, and all exhibited full, soft flaps with no fingertip pain.ConclusionThe combined use of the reverse dorsoradial flap of the thumb and the middle finger proper digital arterial island flap is a practical and effective approach to surgical repair of distal thumb degloving injuries.

Highlights

To examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury
Two cases were associated with distal fractures
The reverse dorsoradial flap of the thumb was designed on the radial dorsal area of the thumb according to the size of the skin defect on the dorsal side of the thumb

Summary

Introduction

To examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury. Distal degloving injuries are common, but reconstruction of the thumb remains a challenge for surgeons [1]. The reverse dorsoradial flap of the thumb or the middle finger proper digital arterial island flap is widely used to repair thumb tip defects [10, 11]. Due to the limited area that can be repaired using a single flap, neither approach on its own is suitable for treating thumb degloving injuries involving large defective areas. In this study, we aim to assess the combined use of the reverse dorsoradial flap of the thumb with middle finger proper digital arterial island flap to repair twelve cases of distal thumb degloving injuries

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