Soft Tissue Defects Of Hand Research Articles

Comparison of the efficacy of medial tarsal venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects: A new type of physiological flap.

The treatment of hand soft tissue defects primarily relies on flap reconstruction. However, traditional venous/arterial free flaps have several disadvantages, including damage to the donor site, bruising, discoloration, blister formation, and even necrosis. These issues can significantly impact patient recovery and outcomes. Therefore, there is a need for alternative approaches that minimize these complications and improve overall patient care. To compare the efficacy of medial tarsal venous flaps and traditional venous/arterial free flaps in the reconstruction of hand soft tissue defects, evaluating various clinical outcomes and patient recovery metrics. We screened 30 suitable patients with hand soft tissue defects and randomly assigned them to three groups. Patients in each group were transplanted with either medial tarsal free venous flaps or traditional arterial/venous free flaps to achieve coverage and reconstruction of the soft tissue defects. The results were compared and analyzed using the following metrics: operation time, survival rate, complication rate, pain index, postoperative infection rate, and functional evaluations of both the donor and recipient areas. There was no significant difference in operation time between the medial tarsal free venous flaps and the traditional forearm free venous flaps. The operative time for both types of flaps was shorter than that of the traditional free fibular flap from the hallux. The survival rate of the medial tarsal free venous flaps was comparable to that of the fibular free arterial flaps from the great toes and significantly higher than that of the traditional forearm free venous flaps. The complication rate showed an inverse trend to the survival rate of the flaps. In terms of pain, the pain index for the medial tarsal free venous flaps was significantly lower than that of the fibular free arterial flaps from the hallux and comparable to that of the forearm free venous flaps. Regarding postoperative infection rates, the forearm free venous flap had the highest rate, while there was no significant difference between the medial tarsal free venous flaps and the fibular free arterial flaps from the great toes. The functional recovery of the medial tarsal free venous flaps was good in both the donor and recipient areas. There was no poor functional performance in the donor areas of the fibular free arterial flaps from the hallux or the recipient areas of the forearm free venous flaps. The medial tarsal free venous flaps effectively avoid the disadvantages of traditional venous and arterial free flaps, combining their advantages. These flaps offer shorter operative times, higher survival rates, and lower pain indices. They also provide excellent functional recovery in both donor and recipient areas. Thus, medial tarsal free venous flaps represent an ideal solution for reconstructing hand soft tissue defects.

Investigating the Thickness of the Deltoid Free Flap Using Ultrasonography and Clinical Application in Foot and Hand Soft-Tissue Defect Reconstruction.

Although the deltoid flap is widely described as a thin flap, no studies have reported on the measurement of its thickness. Thus, this study aimed to measure deltoid flap thickness at different points using brightness-mode ultrasonography and report our initial clinical experience. This study included 36 adults (26 males and 10 females; mean age: 34 years) with 72 healthy deltoid regions. Ultrasonography was employed to measure flap thickness at eight designated positions. The ultrasonography results were also applied clinically in 30 patients to evaluate its compatibility. The mean deltoid flap thickness was 5.14 ± 0.81 mm, with the thickest point being the emerging point of the flap pedicle. The subcutaneous fat gradually thinned toward the shoulder. No significant differences in the subcutaneous fat layer thickness were observed between the right and left sides, different ages, or the two sexes. Body mass index was the most critical factor related to flap thickness (p < 0.001). All deltoid free flaps were successfully transferred, resulting in good or excellent final clinical outcomes. The ultrasonography results suggest harvesting the deltoid flap upward toward the shoulder area and across the acromion from the emerging position of the flap pedicle to optimize flap thinness. The results showed that besides the flaps that have been clinically well established, the deltoid flap should be considered a valuable alternative for reconstructing limb soft-tissue defects, particularly where thin flaps are required and favorable aesthetic results are crucial.

Rehabilitative treatment of lower leg injury was studied by using anterolateral free thigh flap with CT scan

ObjectiveIn cases of severe soft tissue loss and deep tissue exposure in the lower part of the leg, microsurgical skin flap transplantation is the primary treatment method. MethodsBased on the anatomy of the descending branch of the lateral circumflex femoral artery and its musculocutaneous perforators, a free, ultra-thin anterolateral thigh perforator flap is designed for the repair of soft tissue defects in hands and feet. This method has been successfully used at our hospital to treat three patients. Postoperative recovery was favorable, with no vascular crises, and all skin flaps survived. ResultsThe aesthetic appearance of the repaired area was approved by patients, and there were no severe complications post-surgery. Patients were followed up for a period ranging from 6 to 24 months, averaging 14 months. The skin flaps were soft and elastic, without swelling, and the color matched that of normal skin, with good sensory function recovery. ConclusionIn surgical treatment of lower leg wounds, prioritizing using a free anterolateral thigh flap can enhance the repair of the wound and expedite functional recovery postoperatively.

Application of Reversed Radial Forearm Flap for Reconstruction of a Dorsal Hand Soft Tissue Defect: А Clinical Case

Worldwide, surgical techniques for soft-tissue hand defects have made use of the reversed radial forearm flap. Generally, has been used in dorsal hand defects. In this case report, we showed the outcome of a case where the reversed radial forearm flap was applied to treat the dorsal hand defect. A 45-year-old patient who was injured in November 2020 as a result of stacking the right hand in the rotational mechanism. The injury was received 3 days before admission to the hospital. The first stage of surgical treatment was performed - necrectomy of the wound of the right hand. Afterwards, therapy using vacuum-assisted closure (V.A.C) was administered for 18 days. Once granulations had formed in the wound, the patient underwent the second phase of surgical intervention. The reversed radial forearm flap was turned and placed in order to close an opened, exposed bones and tendons in the dorsum of hand. There was no complication with flap viability in the postoperative period. Patient’s joint range of motion and vital functions were acceptable. This case showed that the Reversed Radial Forearm Flap can also be used in dorsal hand defects.Keywords: flap, pedicled flap, soft tissue injuries, hand injuries

Pedicled Groin Flap for Coverage of Soft Tissue Defect of Hand

Background: Distant pedicle flaps like groin flaps are still considered workhorse flaps for the coverage of soft tissue defects of the hand. In the era of free flaps pedicle flaps are still considered as primary flaps by many surgeons. Pedicle flaps are easy to raise, require less experience and microsurgical facility. Methods: In this retrospective descriptive study, patients in whom groin flap was done for reconstruction of hand soft tissue defects were included from April 2017 to April 2022. Results: Thirty-three flaps were included in this study with an average patients’ age of 34.6 years. There were 24 males and 9 females. All flaps survived and served the purpose of covering wounds. Complications like finger and shoulder stiffness were seen in 18 (54.5%), partial necrosis was seen in 4 (12.1%), marginal necrosis in 2 (6%), and infection was seen in 5 (15.2%) patients. Donor sites were healthy after insetting of the flap and did not show any sign of morbidities like infection or bad scarring. Conclusion:Groin flaps are versatile flaps. Where microvascular free flaps are not possible due to severity of injury or due to unavailability of the facility for microvascular free flap groin flap is an excellent option. With less complication, those flaps can be executed easily.

Reconstruction of soft tissue defects of hand: A systematic approach.

A thorough insight into the management of hand injuries can shape the approach of a surgeon in order to achieve optimal outcomes for the patients. The aim of this study was to share our experience in reconstruction of the hand and establishing an algorithm for classification and treatment of hand injuries. This is a descriptive cross sectional study and was conducted from January 2020 to August 2022 at Burns and Plastic Surgery center, Peshawar. Data was collected from medical records about the patient demographics, mechanism of injury and type of procedures done. Defect size was classified into small (<5cm), medium (5cm to 10 cm) and large (>10cm). The defect site and size was cross tabulated against the method of soft tissue reconstruction in order to make the algorithm for reconstruction of hand injuries. Data was analyzed using SPSS. The study population included 41 (75.9%) male and 13 (24.1%) female patients, mean age 31.56±14.1. Machine injuries (33.3%) and electric burns (24.1%) were the most common cause of hand soft tissue defects. The most commonly performed flap was Posterior introsseous artery (PIA) flap, followed by First dorsal metacarpal artery (FDMA) flap. Flap necrosis was observed in three cases (5.6%). This treatment algorithm for coverage of soft tissue defects in hand injuries will help with the decision making process of hand reconstruction and has didactic value for novice surgeons. It will also form the foundation for further work on this aspect of hand injuries.

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Improving the Early Outcome of Digital Replantation: Technical Tricks Learned in a US Fellowship

Abstract Background Despite stable numbers of upper limb amputations there is a decline in replantation in Europe. This results in lacking experience, decreasing success rates, and fewer attempts. Training in high-volume centers is crucial for hand surgeons performing upper extremity replantation. Aims This abstract highlights the experience in a US microsurgery fellowship. Methods Upper extremity revascularization and replantation cases during a 10 month - period were retrospectively reviewed. Overall, the fellow was exposed to 29 cases: 2 hand, 5 thumb and 9 digitial replantations as well as 13 thumb and digital revascularizations. Primary outcome was the survival of the injured body part. Secondary outcomes were total case time, number of repaired arteries/veins, the use of vein grafts, and early free flap coverage. Whenever possible, all microsurgical steps including vessel debridement and anastomosis were performed under tourniquet. Results Success rate was 21/29 (72%). Failure was limited to avulsion or crush injuries. Mean surgery time for revascularization was 92 min (range, 45-134 min) per digit. Mean surgery time for thumb and single digit replantation was 133 min (range, 62-270 min) and for the two hand replantations 180 min and 300 min, respectively. Routinely, only 1 dominant artery was repaired. Forearm or saphenous vein grafts were used in 14/29 cases. Only in 3/23 cases &amp;gt; 1 vein was repaired and in 3 cases interpositional vein grafts were used for dorsal vein reconstruction. One venous flow-through flap was used and a dorsal hand soft tissue defect was covered with a fascio-cutaneous free flap 5 days after replantation. Conclusions Replantation remains a challenge for hand surgeons. The thoughtful use of a tourniquet with vessel debridement in a bloodless field is key to maximize the efficiency of replantation. Furthermore, the liberate use of vein grafts and venous flow-through flaps helps moving outside the trauma zone, thus increasing the likelihood of upper limb salvage.

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Clinical outcomes of a novel porcine small intestinal submucosa patch for full-thickness hand skin defects: a retrospective investigation

ObjectiveTo investigate the clinical outcomes of a novel soft tissue repair patch (porcine small intestinal submucosa patch, SIS patch) in the treatment of full-thickness hand skin defects.MethodsFrom January 2017 to July 2019, 80 patients with hand soft tissue defects, who met the inclusion criteria, were retrospectively reviewed and divided into two groups. After debridement, patients in group A were treated with the novel SIS patch to cover the wound, and patients in group B were treated with autologous skin graft. The dimensions of skin defect area and healing outcome were evaluated and recorded. Scar assessment was carried out using Scar Cosmesis Assessment and Rating Scale (SCAR scale) at the last follow-up postoperation, and the recovery of wound sensation was assessed at the same time using British Medical Research Council (BMRC) grading of sensorimotor recovery. All the data were collected and statistically analyzed.ResultsA total of 80 patients were enrolled in the study with 40 patients in each group. Four patients in group A and 5 patients in group B were excluded due to wound infection and lost to follow-up. There were 36 patients in group A and 35 patients in group B finally got follow-up postoperation with mean interval of 12.75 ± 5.61 months in group A and 14.11 ± 5.42 months in group B. The dimensions of skin defect area in group A ranged from 7.5 to 87.5 cm2 (mean 25.97 ± 18.66 cm2) and in group B ranged from 7.5 to 86.25 cm2 (mean 33.61 ± 19.27 cm2) which have no significant difference (P > 0.05). SCAR scale results of group A and group B were 10.98 ± 0.33 and 9.49 ± 0.35, respectively, and the difference was statistically significant (P < 0.05). BMRC grading results showed 6 cases of S4, 11 cases of S3+, 5 cases of S3, 6 cases of S2, 6 cases of S1 and 2 cases of S0 in group A, and 8 cases of S4, 10 cases of S3+, 7 cases of S3, 4 cases of S2, 5 cases of S1, and 1 case of S0 in group B, which had no significant difference between them (P > 0.05).ConclusionsThe novel SIS patch is an applicable biological material in the treatment of hand skin defect, which could achieve a better cosmetic appearance of the newborn skin tissue.

Retracted: Clinical Application of Artificial Dermis and Autologous Skin in Repairing Skin and Soft Tissue Defects of Hands and Feet with Bone Exposure Injuries.

[This retracts the article DOI: 10.1155/2021/1202826.].

Assessment of Flap Viability and Post-operative Hand Function After Resurfacing of Acute Soft Tissue Injury onthe Palm of Hand byGroin Flap and Reverse Pedicled RadialForearm Flap

Background: Many flaps have been described and used for coverage of various soft tissue defects of hand, which can be regional or distant. Objective: In this study main goal is to evaluate the assessment of flap viability and post-operative hand function by Total Active Motion (TAM) and Hand grip strength. Method: This was a comparative observational study, conducted at department of Orthopaedic Surgery and Burn and Plastic surgery in Sylhet MAG Osmani Medical College Hospital (SOMCH) from January 2018 to October, 2019. A total of 16 patients with acute hand injury or pathology in the palm which may create surgical wound, admitted in the study place during the study period were the study population. Where those who had Acute wound in palm with exposed tendon, nerve and bones or degloving hand injury were included in the study. Patient were divided into two group namely Group-A and Group-B. Patient chosen for groin flap were allocated in group-A and for reverse pedicled radial forearm flap were in group-B. Results: During the study, complete flap survival was 100% in both group A and B. At all the follow-ups hand grip strength was more in group B and the difference was statistically significant (p&lt;0.05, obtained by unpaired t-test). At final follow-up (12 weeks) hand grip strength was 22.38 (SD±5.26) kg in Group A and 30.13 (SD±10.15) kg in Group B.There is no(0.0%) excellent result of index and middle finger in group A patient compared to 3 (37.5%) and 6 (75.0%) patients respectively in group B. Ingroup A3 patient had excellent outcome in ring fingercompared to 7 (87.5%) patients in group B. Majority (87.5%) patient‘s little finger was excellent in group A and 8(100.0%) in group B.The difference of index finger and middle finger were statistically significant between groups (p&lt;0.05 obtained by Fisher Exact test). Conclusion: From this study we can say that, both the handgrip strength and TAM score was better in patients who underwent radial forearm flap and the difference was statistically significant (p&lt;0.05). It is concluded that reverse pedicled radial forearm flap has better outcome regarding flap viability and post-operative hand function than groin flap.

Usefulness of Reverse Radial Forearm Flaps in Covering Soft Tissue Defects of Hand and Wrist

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

Versatility and reliability of reverse posterior interosseous artery flap for coverage of soft tissue defects of hand and wrist.

Objective: To evaluate reverse PIA flap in reconstruction of various types of soft tissue defects of the hand in terms of reliability, flap survival, total duration of hospital stay, patient’s satisfaction and duration of return to work Study Design: Case Series study. Setting: Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: January 2018 to July 2020. Material &amp; Methods: Twenty three posterior interosseous artery flaps were used for coverage in patients who had soft tissue defects over hand dorsum, wrist and first web space. Both sexes were included with age group ranging between 15 to 60 years. Results: Twenty two flaps, out of total 23 survived completely. In one patient, there was partial flap necrosis for which skin grafting was done. Donor sites were successfully covered with skin grafts. All patients went on to resume their work within a month or two and were quite satisfied with aesthetic outcome. Conclusion: A well planned reverse PIA flap is not only a safe, versatile and reliable option for coverage of hand defects but also entire has the benefit of a shorter hospital stay, allowing early return of patient to work and superior aesthetic outcome.

Reconstruction of the soft tissue defects of hand and wrist with ulnar artery perforator flap-presentation of case series

Reconstruction of soft tissue defect of hand and wrist is a common problem to plastic surgeon. I reconstructed the defect, both dorsal and palmar surface with a perforator-based flap from ulnar artery. The aim of the present study is to evaluate ulnar artery perforator flap in soft tissue defect of hand and wrist. Between January 2018 to February 2021, seven cases of skin defect were reconstructed with a perforator-based flap from ulnar artery, either pedicled or propeller type flap. The study was done at NRS medical college, Kolkata, where I have evaluated the viability of the flap, post-operative complication and patient’s satisfaction. All flaps survived, only in one case there was marginal necrosis that was treated conservatively. There was no post-operative complication, all flaps were doing well in six month and one year and one and half year follow up and patient’s satisfactions were also good. Ulnar artery perforator based fasciocutaneous flap, pedicled or propeller provides a reliable coverage of soft tissue defects of hand as well as wrist.

Clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap

Objective: To observe the clinical effects of bridge-type continuous negative pressure suction in postoperative fixation of upper limb soft tissue defect wound repaired with pedicled abdominal flap. Methods: The retrospective observational study was conducted. From April 2018 to October 2020, ninety-five patients who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 55 males and 40 females, aged 5-78 years, with a defect wound area of 82 (9, 216) cm2. All patients underwent abdominal flap repair for soft tissue defects of hand and forearm. According to the different fixation methods adopted in the operation area, the patients were divided into negative pressure group (n=48) and plaster group (n=47). Wounds of the injury sites of patients in the 2 groups were repaired by flap transplantation after debridement. The negative pressure suction device was placed after dry gauze dressing to form a "bridge" to fix the affected upper limb and chest and abdomen in negative pressure group. Patients in plaster group were treated with conventional dry gauze matting and plaster fixation. On post surgery day (PSD) 1, 3, 5, 7, and 14, flap blood circulation and pain intensity of patients in the 2 groups were calculated by self-made blood flow scoring scale and Changhai Pain Ruler, respectively. On PSD 5, the common complications in operative area and surrounding skin were observed and their incidences were calculated. On PSD 7, satisfaction degree of patients was scored. During follow-up of one month after pedicle division, the appearance and functional recovery of the affected limb were observed. Data were statistically analyzed with analysis of variance for repeated measurement, independent samples t est, Cochran & Cox approximate t test, chi-square test, and Wilcoxon rank-sum test. Results: On PSD 1, 3, 5, 7, and 14, the flap blood circulation scores of patients in negative pressure group did not change significantly, while that of patients in plaster group showed a time-dependent decrease, and the flap blood circulation scores of patients in negative pressure group were significantly higher than those in plaster group (t=2.259, 2.552, 2.784, 2.821, 3.003, P<0.05 or P<0.01). There were no significant changes in the pain intensity scores of patients in negative pressure group, while those of patients in plaster group increased in a time-dependent manner, and the pain intensity scores of patients in negative pressure group were significantly lower than those in plaster group (t=-4.818, -4.944, -5.011, -5.976, -6.721, P<0.05). On PSD 5, the incidences of common complications in operative area and surrounding skin of patients in negative pressure group were significantly lower than those in plaster group (χ2=6.773, 5.269, P<0.05 or P<0.01). On PSD 7, the satisfaction score of patients in negative pressure group was 14.7±1.1, which was significantly higher than 7.4±1.8 in plaster group (t=23.934, P<0.01). During follow-up of one month after pedicle division, the appearance and function of the affected limb of patients in the 2 groups recovered well. Conclusions: After repairing the upper limb soft tissue defect wound with pedicled abdominal flap, the bridge-type continuous negative-pressure suction fixation can effectively immobilize the affected limbs, chest and abdomen, reduce the incidence of common complications in the operative area and surrounding skin, relieve the pain of immobilization of patients, improve the blood circulation of flap and patient's satisfaction. Thus, it is an effective, portable, comfortable, and easy-to-operate method.

Clinical Application of Artificial Dermis and Autologous Skin in Repairing Skin and Soft Tissue Defects of Hands and Feet with Bone Exposure Injuries.

Patients with skin and soft tissue defects are very common. Mild trauma often causes mild skin damage, while severe injuries are often accompanied by bone and tendon exposure, which brings great pain to patients. For the defect of skin and soft tissue, the traditional treatment methods are mostly medium or full-thickness skin or skin flap transplantation. These methods are effective in wound repair, but there are still many problems. In recent years, with the improvement of tissue engineering technology, the use of artificial skin to repair various skin wounds is gradually becoming clinical, and the key technology of skin tissue engineering lies in the development of dermal substitutes. The appearance of artificial dermis not only solves the shortage of autologous skin source but also makes the operation simple and easy. The purpose of this study was to investigate the clinical effect of artificial dermis combined with autologous skin grafts in repairing hand and foot skin and soft tissue defects with bone exposure. The results show that the use of artificial dermis combined with autogenous blade thick skin to treat patients with hand and foot soft tissue injury with bone exposure has a good clinical effect, and the skin is alive and has fewer complications, which is worthy of promotion.

Free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand

BackgroundHand injury is commonly associated with multiple soft tissue defects. Polyfoliate flaps grafting is the optimal approach for multiple wounds.The feasibility of clinical using of free thoracodorsal artery polyfoliate perforator flaps for repairing multiple soft tissue defects in the hand needs to be confirmed in clinical practice.MethodsFifteen patients with hand soft tissue defects that were repaired using free thoracodorsal artery polyfoliate perforator flaps from January 2015 to February 2018 was retrospectively analysed. The survival rate, the operative time, the appearance and sensory recovery of the flaps, and hand function were evaluated.ResultsThe flaps of all 15 patients survived. Vascular crisis occurred in one patient, and the flap was saved after exploratory operation. The 15 patients were followed up for 12–26 months. Sensation in the flaps was partially recovered in all 15 patients. The wound in the donor area was closed directly with sutures. Mean score of scars at the donor site were assessed using the modified Vancouver scar scale (VSS) was 2.7. A puffed appearance in the recipient area was noted in four patients. To obtain a more satisfactory appearance, revision of the flap was performed once in these four patients. The Total Active Movement (TAM) evaluation system was used to assess the results, which were considered excellent in seven patients, good in six patients, fair in two patients, and poor in none of the patients. Ten of the 15 patients returned to their primary jobs.ConclusionFree thoracodorsal artery polyfoliate perforator flaps are appropriate for repairing multiple soft tissue defects in the hand, offer a satisfactory appearance, require a short operative time, and have little impact on the function and aesthetics of the donor site.

Clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand

Objective: To investigate the clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand. Methods: The retrospective observational study method was used. From May 2014 to June 2019, 8 patients with thumb damage and soft tissue defect of hand were admitted to the 988th Hospital of Joint Logistic Support Force of PLA, including 6 males and 2 females, aged from 25 to 46 years. Among them, thumb damage in 3 cases were degree Ⅱ, 1 case was degree Ⅲ, and 4 cases were degree Ⅳ. All thumb damage were repaired with perforator flap combined with toe transplantation. The skin and soft tissue defects of hand were repaired by free anterolateral thigh perforator flap in 6 cases and free deep inferior epigastric perforator flap in 2 cases. The thumb damage of degree Ⅱ was repaired by the first toe transplantation combined with perforator flap, and thumb damage of degree Ⅲ or Ⅳ was repaired by the second toe transplantation combined with perforator flap. The survival and blood supply of reconstructed thumbs and flaps, and wound healing of donor sites were observed after surgery. All the patients were followed up for 10 to 18 months, the appearance of the reconstructed thumbs, sensory recovery, and foot walking function were observed. At the final follow-up, the functional reconstruction of the thumb was evaluated. Results: All the blood supply and survival of the reconstructed thumbs and flaps were good, and all the wounds of donor sites healed well. During the follow-up, the appearances of the reconstructed thumb and flap were good, the sensation of pain and touch of the finger pulp recovered well, and no significant impact on foot walking function was observed. At the final follow-up, the function of reconstructed thumb was evaluated as excellent in 4 cases, good in 3 cases, and fair in 1 case. Conclusions: The repair method of perforator flap combined with toe transplantation technique can complete the targeted repair of thumb damage with skin and soft tissue defect of hand in one stage, minimizing the foot donor site injury and shortening the course of disease and early rehabilitation, which is one of the ideal methods for the treatment of complex thumb damage.

Clinical Effect of Holistic Nursing in Treating Traumatic Soft Tissue Defect of Hand and Foot with VSD Technique

Clinical Effect of Holistic Nursing in Treating Traumatic Soft Tissue Defect of Hand and Foot with VSD Technique