The wrap-round la flap with part toenail combined with the second simepulp flap for repair of total avulsion of fingers

Abstract

Objective To explore the method for repair of total avulsion of 2 -4 fingers and to find the best procedure. Methods The wrap-round flap with part toenail combind with the dorsal pedical flap to repair soft tissue defect of the dorsal of finger and part of the palmar of finger, the second simepulp flap to repair soft tissue defect of the palmar of finger, transfer of two tissues with one pedicle to repair total avulsion of 2-4 fingers. Results All of 9 composite transplants in 6 cases were survived, the received areas were primary healing in 8 finger, 1 case repaired by the bilateral wrap-round flaps and second simepulp flaps for index and middle finger, the distal phalanx of middle finger necrosis because of dislocation of DIP, 3 months later, injury healed after the necrosis of phalanx excised, but the nail and the nail bed were dead. Except 1 case which the grafted skin necrotized in the donor area of the big toe, the rest had primary healing. All cases were followed up 6 -14 months, the activity of joints were： MP 0-70, PIP 0-40. The repaired pulps had excellent appearance, the nail was fine, 1 finger＇ s mail was atrophy and 1 finger＇ s nail was defect. The donor area had good fountion without pain and edema, the grafted skin had normal color and the activity of joints were nomal. Condusion The wrap-round flap with part toenail combined with the second simepulp flap is a good approach in treatment of the skin avulsion injury in the finger. Key words: Finger; Avulsion injury ; Toenail flap ; Transplantation ; Microsurgery