Branch Of Proper Digital Nerve Research Articles

Repair of digital volar complex soft tissue defect with heterodigital antegrade digital artery island flap innervated by digital nerve

To investigate the effectiveness of heterodigital antegrade digital artery island flap innervated by proper digital nerve and the dorsal branch of proper digital nerve for repairing digital volar complex soft tissue defects. Between May 2014 and January 2018, 27 patients with digital volar complex soft tissue defects were treated. There were 17 males and 10 females with an average age of 37 years (range, 18-60 years). The causes included electric saw injury in 8 cases, twisted injury in 12 cases, and heavy pound injury in 7 case. There were 9 thumbs, 5 index fingers, 6 middle fingers, 3 ring fingers, and 4 little fingers. The interval between injury and admission ranged from 1 to 4 hours (mean, 2.5 hours). The defect size ranged from 2.2 cm×1.4 cm to 3.8 cm×2.3 cm. The mean length of unilateral proper digital nerve defect was 2.9 cm (range, 2-4 cm). All defects were repaired with heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve. The proper digital nerve and the dorsal branch of the proper digital nerve in the flap were anastomosed with the proper digital nerve stumps in the wound. The flap size ranged from 2.4 cm×1.6 cm to 4.1 cm×2.6 cm. A segment of dorsal branch of the proper digital nerve was intercalated into the defect of the proper digital nerve in donor site. And the defect of donor site was repaired with the full-thickness skin graft. All flaps and skin grafts survived, and the wounds healed by first intention. All patients were followed up 12-24 months (mean, 17 months). The appearance, color, and texture of the flaps were similar to the surrounding tissue. There was no pain and double sensibility in any flap. At last follow-up, the static two-point discrimination of the flaps ranged from 4 to 8 mm (mean, 5.3 mm). And the two-point discrimination of digital pulps of recipient and donor fingers ranged from 4 to 10 mm with the average of 6.2 mm and 6.0 mm, respectively. According to the functional assessment criteria of the upper limb formulated by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 18 cases and good in 9 cases. No scar contracture was observed in donor site. The heterodigital antegrade digital artery island flap innervated by the proper digital nerve and the dorsal branch of the proper digital nerve provides a safe and simple technique with minimal donor site cost and satisfactory effectiveness, which could be an ideal option for repairing digital volar defect, especially for the defect complicated with digital nerve defect.

Modified Heterodigital Neurovascular Island Flap for Sensory Reconstruction of Pulp or Volar Soft Tissue Defect of Digits

We report the efficacy of a modified heterodigital neurovascular island flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve, for repairing either pulp or volar defects in the fingers. We repaired 14 digits of 14 patients who had a complex defect involving soft tissue and digital nerve in the pulp or volar surface of the digit using the modified heterodigital neurovascular island flap. Cases were divided into 2 groups: a pulp defect group including 5 thumbs and 1 little finger; and a volar defect group with a digital nerve defect, involving one thumb, 3 index and 3 middle fingers, and one ring finger. At the recipient site, nerve stumps of the PDNs in the pulp defect group were coapted with the proximal ends of the dorsal branch of the PDN and the proper digital nerve in the flap. The distal and proximal ends of the PDN in the flap were intercalated into the defect of the PDN in volar defect group, and the proximal end of dorsal branch of PDN in the flap was also coapted to the proximal end of the proper digital nerve of the recipient finger. At the donor site, the defect of the proper digital nerve was repaired with nerve graft harvested from the proximal portion of the dorsal branch of the same proper digital nerve, and a full-thickness skin graft covered the donor site. All flaps and the skin grafts of the donor site survived completely. At the final follow-up, 9 of 14 flaps had a static 2-point discrimination result below the normal threshold (< 6 mm). The modified heterodigital neurovascular island flap is a useful and reliable treatment option for a digital pulp or volar defect, especially when the digital nerve defect requires repair. Therapeutic IV.

Clinical application of the dual V-Y advancement flap based on proper digital artery perforator with sensory reconstruction for repair of soft tissue defects of fingers

Objective To explore the feasibility of the dual V-Y advancement flap based on proper digital artery perforator with sensory reconstruction for repair of soft tissue defects in the middle part of the fingers. Methods From January 2012 to December 2016, 18 patients with soft tissue defects of the dorsal fingers in different segments except for the distal segment were treated by V-Y advancement flap based on proper digital artery dorsal perforator with dorsal branch of proper digital nerve near the proximal and distal wounds. Results The flap and donor site achieved primary healing. All the patients were follow-up from 3 to 22 months with an average of 11 months. The appearance and texture of the flap and finger were good. Three months after the operation, the results of TAM were excellent in 13 cases, good in 4 cases and fair in 1 case. The sensory recovery of flaps was evaluated as S3in 2 cases, S3+in 4 cases, S4 in 12 cases. Conclusion The application of V-Y advancement flap based on proper digital artery dorsal perforator with dorsal branch of proper digital nerve near the proximal and distal wounds to repair the soft tissue defects of the dorsal fingers has the advantages of safety and convenience with high survival rate, good postoperative sensory recovery and satisfactory appearance of the injured fingers. Key words: Finger injuries; Surgical flaps; Proper digital artery perforator; Sensory reconstruction

The retrograde island flap of the dorsal branch of the digital artery with the dorsal branch of the proper digital nerve in repair of the finger pulp defect

目的 应用带指固有神经背侧支的指动脉背侧支逆行岛状皮瓣修复指腹缺损。 方法 自2005年9月至2016年12月，根据指动脉背侧支、指固有神经背侧支的解剖基础，在手指近、中节背侧设计逆行岛状皮瓣，携带指固有神经背侧支，修复指腹缺损创面，重建指腹的感觉，共48例51指，皮瓣切取面积1.5 cm×1.5 cm~2.5 cm×3.5 cm。 结果 术后皮瓣全部存活，随访6~26个月，平均13.5个月。修复后的指腹外形良好，质地柔软、耐磨，无明显触痛，两点分辨觉7~11 mm，平均8 mm，指间关节活动正常。 结论 带指固有神经背侧支的指动脉背侧支逆行岛状皮瓣，不损伤手指主要血管、神经，手术简单、安全，可同时修复指腹创面及重建指腹感觉，效果满意。

Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger.

This article defines a sensate, pedicled heterodigital flap from the proximal radial side of the index finger for reconstructing large soft tissue defects of the thumb. The pedicle consists of the radial digital artery of the index finger. Dorsal sensory branch of proper digital nerve and one of the terminal sensory branches of radial nerve are included in the flap for sensation. The results of 17 consecutive patients at 24 months revealed mean static two-point discrimination of 7 mm at the reconstruction site and 10 patients were able to feel 4 mm at the reconstructed thumb. The mean range of motion of metacarpophalangeal and interphalangeal joints of operated thumbs reached 94% and 66%, the mean grip span reached 96% compared with the uninjured side. The presented flap provided a simple yet favourable alternative for reconstruction of the thumb tip, with thick and durable tissue requiring minimum dissection and donor side morbidity. Level of evidence: IV.

Reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip

Objective To explore the clinical outcomes of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip. Methods From March 2014 and June 2016, 25 patients (30 fingers) of fingertip soft tissue defects were treated using reverse dorsal digital island flap with cutaneous branches of proper digital nerve. The proper digital cutaneous branches of the flap were sutured with the digital nerve of the wound. The fingertip defect area ranged from 1.4 cm×1.6 cm to 2.0 cm×3.5 cm (average, 2.1 cm×2.5 cm). The flap area was enlarged by 10%. The donor sites were covered with autologous full-thickness skin. Results All the flaps survived. All the donor and recipient wounds achieved primary healing. Venous crisis occurred in one case which healed after the removal of some sutures. Postoperative follow-up period ranged from 6 to 18 months. The shape of the flaps was plump and the texture was soft. Partial superficial sensation of the flaps recovered without donor site pain and interphalangeal joint dysfunction. The two-point discrimination ranged from 5 to 8 mm, with the average being 5.7 mm. According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association, the results were excellent in 17 cases, good in 8 cases. Conclusion The application of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip can achieve good sensory recovery. Key words: Finger injuries; Surgical flaps; Treatment outcome; Sensory reconstruction

Anastomosis of dorsal branch of the proper digital nerve dorsal distal interphalangeal joint perforator flap to repair finger tip defect of skin tissue

Objective To Summarize the application of digital artery dorsal distal interphalangeal joint perforator flap to repair finger tip skin defect, and at the same time, the method and effect of anastomosis of finger dorsal branch of digital nerve sensory reconstruction. Methods From September 2012 to March 2015, 78 patients 92 fingers were treated in Orthopedics Department of Jinshan Branch Hospital of the Sixth People′s Hospital of Shanghai, all patients with finger artery distal interphalangeal joint dorsal cutaneous branches of the dorsal flap pedicled with retrograde, transferred to repair the skin defect of finger end, and anastomosis of dorsal branch of the proper digital nerve reconstruction. Results Postoperative vascular crisis occurred in 8 cases, 2 cases of partial flap necrosis and healed after symptomatic treatment.All flaps survived, the wounds healed in I stage, and the donor site healed in I stage.All the 73 cases were followed up, the follow-up period ranged from 3.0 to 12.0 months, an average of (7.8±2.5) months.The postoperative appearance and feel good, soft texture, abrasion resistance, no tenderness, cold resistance, dynamic two-point recovered to 4.0-8.0 mm, average (5.3±0.9) mm.Static two-point discrimination was 4.0-9.0 mm, average (5.8±1.2) mm.The method of TAM was used to determine the function of the 67 fingers, good for the 7 finger, but also for the 5 finger and the difference of the 0 finger.The excellent and good rate was up to 93.7%. Conclusion The operation without sacrifice of major arteries and nerves by finger, the middle finger dorsal skin for non functional surface area, and at the same time by anastomosis of dorsal branch of the proper digital nerve reconstruction, without surgery two times, is one of the ideal surgical repair of skin defect of the finger end. Key words: Dorsal branch of digital artery; Perforator flap; Skin defect of finger end; Refers to the inherent nerve

Finger pulp reconstruction with innervated reverse digital artery flap through bilateral neurorrhaphy

Objective To investigate the clinical outcomes of finger pulp reconstruction with innervated reverse digital artery flap with the sensory nerve branches through bilateral neurorrhaphy. Methods From April 2014 to March 2015, innervated reverse digital artery flaps with the sensory branches of proper digital nerves were transferred to repair pulp defects of 17 fingers in 15 patients. The flap was designed at the lateral aspect of the proximal phalanx. Two branches of the proper digital nerve that projected towards the flap were included in the flap. After flap inset, these two branches were coapted with the stumps of the bilateral proper digital nerves. Results All the flaps and skin grafts survived uneventfully. These cases were follow-up for 7 to 11 months. The reconstructed pulps had good appearance and supple texture. There was no flap bulkiness or pigmentation. The involved fingers recovered normal active motion. The pain and temperature sensation were recovered in all the flaps. Static two-point discrimination value was 5 to 8 mm, while the average Semmes-Weinstein monofilament score was 3.22 to 3.84. The average Cold Intolerance Severity Score(CISS) was 23 (range, 11 to 44), with 15 patients corresponded to mild cold intolerance and 2 patients corresponded to moderate cold intolerance. According to the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society, the results were rated as excellent in 14 fingers, good in 2 fingers, and fair in 1 finger. Conclusion Satisfactory appearance and sensation of finger pulp can be restored by transferring innervated reverse digital artery island flap with bilateral neurorrhaphy to the branches of the proper digital nerves. Key words: Surgical flaps; Finger injuries; Treatment outcome; Neurorrhaphy

The modified antegrade digital artery island flap for severely flexion contracture of the burned finger

Objective To investigate the clinical outcomes of using modified antegrade digital artery island flap for the treatment of the severely flexion contracture of the burned finger. Methods Between August, 2013 to August, 2015, 21 patients (21 fingers) with severely flexion contracture of the burned finger were hospitalized for treatment. According to the Stren classification standard for the interphalangeal joint flexion contracture, all the patients were rated as type Ⅲ. The volar soft-tissue defect with exposed tendons, nerves, vessels or bone ranged from 1.0 cm × 2.0 cm to 2.5 cm × 4.0 cm after scar relaxation. The artery and the nerve defect were 1.5 to 4.5 cm and 2.0 to 4.2 cm, respectively. The wound were reconstructed with the modified antegrade digital artery island flap. The dorsal branches of the proper digital nerve of the flap were anastomosised with the proper digital nerve of the wound. The flap donor site was resurfaced with full-thickness skin grafting from inner aspect of the forearm. All the cases were called back for postoperative follow-up. Results All the reconstructed fingers and flaps survived completely without vascular problems. The donor skin graft survived and wound healed by first intention. All the patients were followed up with 11.5 months (range, 6-22 months). The finger appearance was satisfactory. The texture and color of flaps in all cases were good. There was no pigmentation and contraction relapse. The contracted fingers received no cold intolerance. At the final examination, the average values of static 2-point discrimination were 5.2 mm (range, 4.3-6.5 mm) of the flap. In the series, based on the Michigan Hand Outcome Questionnaire, 18 patients were strongly satisfied with the injured finger appearance and 3 patients satisfied with the appearance. Conclusion The modified antegrade digital artery island flap, which is easy to raise with large flap size and can result with the good finger appearance and function, is an ideal technique for reconstruction of the severe flexion contracture of the burned finger. Key words: Finger; Burn; Finger flexion contracture; Proper palmar digital artery; Island flap; Microsurgical operation

Treatment of Soft-Tissue Loss with Nerve Defect in the Finger Using the Boomerang Nerve Flap

This study reports simultaneous repair of soft-tissue loss and proper digital nerve defect in the finger using a boomerang nerve flap including nerve graft from the dorsal branch of the proper digital nerve. From July of 2007 to May of 2010, the flap was used in 17 fingers in 17 patients. The injured fingers included five index, seven long, and five ring fingers. The mean soft-tissue loss was 2.5 × 1.9 cm. The mean flap size was 2.8 × 2.1 cm. Proper digital nerve defects were reconstructed using nerve graft harvested from the dorsal branch of the adjacent finger's proper digital nerve. The average nerve graft length was 2.5 cm. The comparison group included 32 patients treated using a cross-finger flap and a secondary free nerve graft. In the study group, 15 flaps survived completely. Partial necrosis at the distal edge of the flap occurred in two cases. At a mean follow-up of 22 months, the average static two-point discrimination and Semmes-Weinstein monofilament test results on the pulp of the reconstructed finger were 7.5 mm and 3.86, respectively. In the comparison group, the results were 9.3 mm and 3.91, respectively. The study group presented better discriminatory sensation on the pulp and milder pain and cold intolerance in the reconstructed finger. The boomerang nerve flap is useful and reliable for reconstructing complicated finger damage involving soft-tissue loss and nerve defect, especially in difficult anatomical regions. Therapeutic, II.

Comparison of repair distal soft tissue defect with two kind of reverse digital artery island flaps

Objective To analysis the clinic outcome (similarities & differences, indication and caution) of repairing fingertip soft tissue defect with two kind of reverse digital artery island flaps with the palmar cutaneous branch of proper digital nerve. Methods From January 2000 to Auguest 2008, all 500cases (514 fingers) were repaired with reverse homodigital artery island flap (263 fingers of 250 cases) and reverse cross finger digital artery island flap(251 fingers of 250 cases).All cases were followed up from 3-8years,compared with flap range,finger extension,sensory rehabilitation,et al. Results All flaps (A & Bgroup) of 500 cases (514 fingers) survived.According to flap range,cross finger flap was better than homodigital flap (P ＜ 0.05); according to finger extension,homodigital flap better than cross finger flap (P ＜0.05); according to sensory rehabilitation,homodigital flap little better than cross finger flap(P ＜ 0.05); according to long-term follow-up, all had no obviously different (P ＞ 0.05). Conclusion Homodigital flap can cover distal soft tissue defect less than 2.0 cm× 2.5 cm, cross finger flap is a better choice for more than 2.0cm×3.0cm of distal soft tissue defect. According to the flap cover area, cross finger flap is first choice,and to finger extension & sensory rehabilitation,homodigital flap is first choice; accoding to finger movements,two kinds of flaps are all good choice. Key words: Homodigital flap; Cross finger flap; Island flaps; Finger; Microsurgery

Transferring dorsal branch of the proper digital nerve to restore sensation of the pulp

Objective To introduce the surgical method of transferring dorsal branch of the proper digital nerve of index, middle or ring finger to the lacerated digital nerve on the opposite side of the same finger or the neighboring finger. Methods From August 2003 to December 2008, 72 lacerated proper digital nerves in 56 cases were repaired by transferring dorsal branch of the proper digital nerve from the opposite side of the same finger or from the neighboring side of the neighboring finger. The transferred nerve was coapted to the distal end of the lacerated nerve. Results All 56 cases were followed for 6 months to 1.5 years postoperatively, with an average of 14 months. Recovery of sensation of the reinnervated finger pulps was observed in all cases. Two-point discrimination was 6 to 9 mm, average being 7.3 mm. Sensory function was rated as S4. The pulps were full in contour. Conclusion Transferring dorsal branch of the proper digital nerve of index, middle or ring finger to the lacerated digital nerve on the opposite side of the same finger or the neighboring finger was a simple and effective method to restore sensory function of the pulp. Key words: Nerve transfer; Finger injuries; Dorsal branch of finger connatural nerve

One-stage repair of soft tissue and nerve defect of the fingers using dorsal island flap

Objective To report the treatment outcomes of repairing soft tissue and nerve defect of the fingers using dorsal island flap carrying dorsal cutaneous branch of the proper digital nerve. Methods The skin and nerve defects in 18 fingers of 16 patients were repaired by dorsal island flap carrying dorsal cutaneous branch of the proper digital nerve. The size of the flaps ranged from 10 mm × 7 mm to 24 mm × 20 mm. The length of the nerve defect ranged from 9 to 22 mm. Results Postoperatively all the flaps in the 18 fingers of 16 patients survived. The average follow-up was 5 to 25 months. The appearance and function of the involved fingers were satisfactory. Sensation of the finger pulp returned to S3+ and two-point discrimination ranged between 4 to 7 mm. Conclusion Using dorsal island flap carrying dorsal cutaneous branch of the proper digital nerve can achieve simultaneous repair of both skin and nerve defects. The treatment outcomes were satisfactory. It is an optimal procedure for repairing combined soft tissue and nerve defect of the fingers. Key words: Surgical flaps; Finger injuries ; Repair

Repairing skin defects of the fingers with a reverse island flap from the dorsum of the proximal phalanx

Objective To investigate the surgical technique and clinical outcomes of a reverse island flap with multiple feeding vessels from the dorsum of the proximal phalanx for repairing skin defects of the fingers. Methods From January 2005 to December 2008, skin defects at the middle or distal phalangeal level in 59 cases with a total of 71 fingers were treated with a dorsoproximal phalangeal reverse island flap. The flap is supplied by multiple feeding vessels including dorsal cutaneous branches of the proper digital artery, nutrient vessels of dorsal cutaneous branches of the proper digital nerve, and the deep fascia vascular network. The size of the flaps ranged from 2.0 cm × 1.5 cm to 4.0 cm× 2.8 cm. Results Postoperatively all flaps survived. The patients were follow-up for 6 to 24 months. The appearance of the repaired fingers was satisfactory. Two-point discrimination of the flaps recovered to 4.5 to 10.0 mm, with an average of 6.6 mm. Movement of the proximal interphalangeal joint was normal in all cases. There were no obvious complications of the donor site. Conclusion The dorsoproximal phalangeal reverse island flap with multiple feeding vessels has reliable blood supply, does not sacrifice a major artery and can restore good flap sensation. It is an ideal flap for repairing skin defects of the fingers at the middle or distal phalangeal level. Key words: Surgical flaps; Finger injuries; Treatment outcome

Repair of skin defects of the fingers with dorsal reverse island neurocutaneous flaps from the hand and finger

Objective To evaluate the treatment outcome of using dorsal reverse island neurocutaneous flaps from dorsum of the hand or finger for repair of finger skin defects. Methods Eighteen reverse island flaps (in 18 cases) pedicled on the nutritional vessels of dorsal metacarpal cutaneous nerve and 17 reverse island flaps (in 15 cases) pedicled on the nutritional vessels of dorsal branch of the proper digital nerve were used to repair skin defects of the fingers. The survival rate, texture, colour, and sensation of the flaps were observed.Results Swelling of the flap occurred in 2 cases, while venous crisis was seen in 2 cases. All 35 flaps of the 33 eases survived. Postoperative follow up period ranged from 3 to 18 months, with an average of 12 months. The appearance, texture and elasticity of the flaps were good. Partial recovery of light touch was observed.Conclusion Harvest of dorsal reverse island neurocutaneous flap does not sacrifice major vessels and nerves.The operation is simple. It is an ideal method for repairing soft tissue defects of the finger. Key words: Finger injuries; Surgical procedures, operative; Island flaps

Repair of pulp defect with reverse digital artery island flap including the palmar cutaneous branch of proper digital nerve

目的 报道应用吻合指固有神经掌皮支的指动脉逆行岛状皮瓣修复指腹缺损的临床效果.方法对15例16指末节指腹缺损的患者,应用吻合指固有神经掌皮支的指动脉逆行岛状皮瓣修复,皮瓣切取面积为1.8cm×2.1cm～3.1cm×3.6cm.结果 15例皮瓣全部成活,术后随访6个月～2年,伤指外形与正常指相近,指腹饱满而不臃肿,质地柔软,有排汗功能,两点分辨觉在5～7mm以内.结论应用吻合指固有神经掌皮支的指动脉逆行岛状皮瓣,术后效果好,供区损伤小,是修复末节指腹缺损较理想的手术方法。