Soft Tissue Defects Of Fingers Research Articles

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

Emergency repair of the soft tissue defects of finger by transplantation of flow-through composite tissue flap with the joint from the second toe

Objective To evaluate the clinical efficacy of transplantation of flow-through composite tissue flap with the joint from the second toe for emergency repair of the soft tissue defects of finger. Methods From March 2009 to February 2016, 12 cases (15 fingers) of finger composite tissue defects with proximal interphalangeal joint defects were treated by transplantation of flow-through composite tissue flap with the joint from the second toe. The area of the composite tissue flap was 15 mm×10 mm to 40 mm×35 mm. The length of the bone joint was 20 to 42 mm with an average of 28 mm. The length of the proper digital artery was 26 to 38 mm with an average of 30 mm. The length of the proper digital nerve was 22 to 40 mm with an average of 28 mm. Results All the composite flaps of the fingers survived and the wounds achieved primary healing. The follow-up period ranged from 8 to 30 months. The transplanted joints were healed without any degenerative changes or nonunion. Except for 2 cases with mild hypoextension, rest joints were all well-moved. The flexion of the proximal interphalangeal joint of the fingers ranged from 40° to 90° with an average of 65°, and the extension ranged from -10° to 10°. The blood supply of the finger was good, and the two-point discrimination of the fingertip was 6 to 12 mm. The patients were satisfied with the appearance and function of the fingers. According to the hand function evaluation standard issued by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 5 fingers, good in 8 fingers, fair in 1 finger and poor in 1 finger. Conclusion The application of flow-through composite tissue flap of the second toe with interphalangeal joint transplantation for emergency repair of the finger complex tissue defects with joint defects can restore good finger joint function, and reconstruct the blood supply and sensation of the distal finger. It can meet the basic living requirement of the patient, which is one of the ideal methods to repair complicated injuries of the finger. Key words: Finger injuries; Surgical flaps; Joint transplantation; Composite tissue

Application of the first dorsal metacarpal artery flap for repair of soft tissue defects of finger by free transplantation

Objective To summarize the operative procedure and clinical efficacy of the first dorsal metacarpal artery flap for repair of the finger soft tissue defects with bone and tendon exposure by free transplantation. Methods From June 2014 to June 2017, 10 cases of the finger soft tissue defects with bone and tendon exposure were treated by the first dorsal metacarpal artery flap transplantation, and the sensation of the flap was reconstructed using the superficial branch of the radial nerve. The area of the flap ranged from 1.5 cm×4.5 cm to 5.2 cm×6.0 cm. The donor sites were closed directly or by skin graft. Results All the flaps survived successfully without vascular crisis. Primary healing of the flaps and donor sites was achieved. All the cases were follow-up for 6 to 20 months, with an average of 10 months. The shape and color of the flap were close to the healthy side, and the texture was soft. Two-point discrimination was 7 to 12 mm with an average of 8.5 mm. Hand function was evaluated by the total active range of motion of the fingers. The results were excellent in 6 cases, good in 3 cases and fair in 1 case. Conclusion The free first dorsal metacarpal artery flap, which selectively included the superficial branch of the radial nerve, is a reliable and simple procedure. It can effectively cover the wound with lighter injury in donor site and obtain an ideal appearance, function and sensory recovery. Key words: Finger injuries; Surgical flaps; Microsurgery; The first dorsal metacarpal artery

Is the adipofascial flap the key to regenerative surgery?

Objectives“Form and function restoration” is the ultimate goal of reconstructive surgery, which is oriented toward regeneration rather than reparation. Recently, research in reconstructive surgery has focused on the regenerative potential of the adipose tissue. The aim of the study is to illustrate the surgical methods and show the functional and aesthetic results achieved by the reconstruction of finger soft-tissue defects using homodigital dorsal adipofascial reverse flap (HDARF). Materials and methodsA total of 63 cases (45 acute and 18 elective) were included between September 2010 and August 2016. In each case, we preliminarily performed surgical debridement and then harvested an adipofascial flap from the back of the finger. Nine injured thumbs that were repaired with the flap as emergency cases were also included. The average age of the patients was 46 (range: 4–69) years. ResultsAll flaps survived without any complications during the 24-month follow-up. Good nail regrowth through the flap and full regeneration were observed in approximately all cases. Sensitivity tests and histological analysis of biopsy samples of the regenerated fingers confirmed full regeneration of the epidermis, dermis, cutaneous adnexa, and nerves. All the patients were satisfied with the hand functionality and aesthetic appearance. ConclusionThe HDARF represents a very useful alternative for the reconstruction of nailbed crushes, achieving regeneration of injured segments in deformities caused by trauma or infection.

Application of free superficial palmar branch of radial artery flap in repairing of soft tissue defect of fingers

To evaluate the surgical technique and the effectiveness of the free superficial palmar branch of the radial artery flap to repair soft tissue defect of fingers. Between June 2014 and June 2017, 10 cases (10 fingers) of soft tissue defects of fingers were repaired with the free superficial palmar branch of the radial artery flaps. There were 8 males and 2 females with an average age of 29.8 years (range, 23-42 years). The causes of injury included the chainsaw cutting injury in 6 cases, the machine crush injury in 2 cases, and the glass scratching in 2 cases. The time from injury to admission was 1-8 hours with an average of 3 hours. The locations were the volar of the middle of index finger in 3 cases, the volar of the distal of index finger in 1 case, the volar of the distal of middle finger in 3 cases, the ulnar side of distal interphalangeal joint of ring finger in 1 case, and the volar of the distal of the little finger in 2 cases. The area of soft tissue defect ranged from 1.8 cm×0.9 cm to 2.8 cm×2.1 cm, and the area of flap ranged from 2.0 cm×1.0 cm to 3.0 cm×2.3 cm. The donor sites were sutured directly. All flaps survived after operation, and the wounds healed by first intention. The incisions of donor site also healed by first intention with a linear scar. All cases were followed up 6-12 months (mean, 9 months). The appearance and texture of the flaps were satisfactory. The pain sensation, warm sensation, and touch sensation of the flap recovered. At last follow-up, the two-point discrimination of the flap was 6-13 mm (mean, 7.5 mm). According to the assessment of the upper limb function issued by tha Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 8 cases and good in 2 cases. The free superficial palmar branch of the radial artery flap is easy to harvest and anastomose and has small injury. It is an ideal method in repairing of soft tissue defects of fingers.

Repair soft tissue defect of middle-and-distal finger with reversed flap based on cutaneous branch of dorsal metacarpal artery

Objective To observe the treatment outcome of using reversed island flap based on cutaneous branch of dorsal metacarpal artery for middle-and-distal finger soft tissue defect. Methods From May, 2015 to March, 2017, 21 cases of middle-and-distal finger soft tissue defect were treated with reversed island flaps based on cutaneous branch of dorsal metacarpal artery which were designed on the dorsal hand pedicled by dorsal metacarpal artery. The flap was then elevated and rotated at the point where digital common artery was anastomosed with the terminal branch of the dorsal metacarpal artery. The cutaneous nerve included in the flap was anastomosed with the terminal branch of digital nerve to restore sensation and the donor site was covered directly. Regular followed-up was performed after operation. Results Except 1 case was suffered with distal 1/3 skin flap necrosis, flaps were well developed. Postoperative follow-up period was 3 to 12 months. All these flaps recovered with satisfying appearance and quality, excellent sensation with grade S3 to S4 and 5 to 8 mm of two-point discrimination. Range of motion(ROM) of the metacarpalphangeal and interphalangeal joint of the injured fingers was good. The excellent and good rate was 95.2%. Conclusion Reversed island flap based on dorsal cutaneous branch of dorsal metacarpal artery transfer is an ideal method for repairing middle-and-distal finger soft tissue defect. The surgery is simple. Reliable blood supply and sensation can be achieved without sacrificing the primary artery and nerve. There is minor donor site damage and very few complications. Key words: Dorsal metacarpal artery; Surgical flap; Finger injury; Microsurgical operation

Free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound

Objective To explore the surgical method and clinical effects of free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound. Methods From June 2010 to June 2015, 9 cases of thumb defect and adjacent finger soft tissue defects were treated using free second toe transplantation with the first dorsal metatarsal artery flap. The area of the first dorsal metatarsal artery flap ranged from 3.3 cm×2.0 cm to 5.2 cm×3.0 cm. Free skin grafts were used to repair donor site. Results Postoperatively tension blister at the distal end of the flap occurred in 1 case which were healed after removal of stitches and change of dressing. Other reconstructed fingers, flaps and skin grafts achieved primary healing. All the patients were follow-up for 6 to 32 months with an average of 15 months. All the flaps presented good appearance and elasticity with soft texture. The appearance and function of the reconstructed thumbs were good. There was no obvious effect on foot load walking. No skin ulcer occurred in donor site. Conclusion Free second toe transplantation with the first dorsal metatarsal artery flap in reconstruction of thumb and repair of adjacent finger wound is an ideal method for repairing due to the reliable blood supply, safe operation and accordance to repair principle. Key words: Surgical flaps; Microsurgery; Tissue defects; Repair

Repairing the defected volar finger with the free micro-flap based on the superficial palmar branch of radial artery

Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger. Methods From October, 2012 to September, 2015, this flap was used in 25 patients to repair the palmar soft tissue defect of the finger. The artery, the vein and the never in the flaps was anastomosed respectively with that in the recipient site. The donor area was sutured directly. Results All patients were followed-up for a mean of 11 months (range, 6-20 months). All 25 flaps survived. The character of flap was good, the appearance and sensitive function obtained satisfactory resume. At the last follow-up, the two-point discrimination was 5-10mm on the affected side. According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association, there were excellent in 17 cases, and good in 8 cases. The wounds of donor site healed by 1st intention with no visible scars. The function of thumb was not damaged. Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site, the inconspicuous scar, and the good appearance and sensitive function of repaired fingers. Key words: Radial artery, superficial dorsal branch; Finger, palm; Thenar eminence; Repair; Microsurgical technique

Reconstruction of palmar finger soft tissue defects by using first dorsal metatarsal artery Flow-through flap with digital artery and nerve anastomosis

Objective To investigate the treatment of outcomes of repairing soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects. Methods From January, 2014 to June, 2016, 7 patients (4 males and 3 females. Patients′ age ranged from 18 to 45 years, with an average of 28.5 years) with soft tissue defects on the palmar side of the proximal and middle phalanx of the fingers accompanied by proper digital artery and nerve defects were treated by first dorsal metatarsal artery Flow-through flap, application of color Doppler ultrasound was used in the detection of vascular type before operation. The flap area was from 2.0 cm×2.5 cm to 3.5 cm×5.5 cm. All the donor site of the flap were sutured directly. The patients were followed-up in 1 month, 3 months, 6 months, 12 months, 24 months after the surgery, and the results were evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association. Results All flaps survived. These cases were followed-up for 6 to 24 months, average 12 months. All the flaps got satisfactory appearance and good sense function, and 2-PD of the flap averaged 7 mm, ranging from 6 mm to 12 mm. All injured fingers got satisfactory appearance and good sense function, 2-PD of the injured fingers averaged 8 mm, ranging from 6 to 15 mm. The donor site incision healed well, no obvious scar hyperplasia, good function. Conclusion Application of the first dorsal metatarsal artery Flow-through flap to reconstruct soft tissue defects of the palmar finger accompanied by proper digital artery and nerve defects, can achieve good clinical effects. This method can restore the appearance, blood supply and sensation of the injured finger. Key words: Finger injuries; Proper palmar digital arteries; Flow-through flaps; First dorsal metatarsal artery

Application of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation

Objective To research the surgical procedure and clinical effects of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation. Methods From March 2010 to May 2015, 21 cases of finger soft tissue defects were treated with proper digital artery island flaps of adjacent digit. The artery or nerve defect ranged from 1.5 to 4.0 cm. The skin and soft tissue defects area ranged from 1.5 cm×1.0 cm to 4.0 cm×2.0 cm. During the operation, proper digital artery and its island flaps were obtained from adjacent side margin of adjacent digit, and transferred to repair skin and soft tissue defects and reconstruct blood circulation simultaneously. The nerve defect was bridged by forearm or foot dorsal cutaneous nerve graft. Results Vasospasm occurred in 2 cases during intraoperative dissection, which was relieved after local application of papaverine and hot warm saline. Vascular crisis occurred in one case 2 hours after the operation, which was relieved by operative exploration. The rest flaps survived uneventfully. The follow-up period ranged from 6 to 48 months with the average being 18 months. The appearance and texture of the flaps were good. Partial protective sensations were restored. The original appearance and function of the injured finger were recovered. No dysfunction occurred in donor fingers. According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association, the results were excellent in 13 cases, good in 6 cases, fair in 2 cases. Conclusion Application of proper digital artery island flaps of adjacent digit for repair of finger soft tissue defects and reconstruction of blood circulation not only has the clinical effect of flow-through flap, but also has the advantages of simplicity, safety and reliability, which is worth promoting. Key words: Finger injuries; Surgical flaps; Flow-through flaps; Transfer repair

Application of neurovascular pedicle V-Y flap for repair of distal finger soft tissue defect in II area

Objective To discuss the operation method, treatment effect and clinical significance of neurovascular pedicle V-Y flap for repair of distal finger soft tissue defect inⅡarea. Methods From May 2014 to August 2016, 12 cases (12 fingers) of distal finger soft tissue defect inⅡarea were treated with neurovascular pedicle V-Y flap. All the wounds were accompanied by tendon or bone exposure and onychostroma residual. The flap area ranged from 2.0 cm×2.0 cm to 2.0 cm×2.5 cm. The donor site was closed directly. Results All the 12 flaps of 12 fingers survived uneventfully. Ten cases were follow-up for 6 to 12 months, and 2 cases were lost. Postoperatively the flaps had satisfactory appearance with the two-point discrimination ranging from 4 to 6 mm. Conclusion The neurovascular pedicle V-Y flap is a reliable and safe way to cover the distal finger soft tissue defect inⅡarea with tendon or bone exposure, which has the advantages of durability, safety and popularity due to the appearance and sensory recovery and no damage to donor sites. Key words: Finger injuries; Surgical flaps; Skin defects; Neurovascular pedicle; V-Y flap

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis.

Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction.

The anatomy basis and clinical application of the horn fasciocutaneous perforator flaps for the reconstruction of the defects on finger soft tissue

To discuss the clinical effect of horn perforator flaps for the treatment of finger soft tissue defect. ① Lead oxide-gelatin mixture injection and CT scanning were performed in 4 fresh adult cadavers and the data was put into mimics 17.0 to achieve the three-dimensional reconstruction. The regulation and origins of the perforator vessel in proper palmar digital artery was observed. ② From July 2012 to July 2015,9 cases with finger soft tissue defects were treated with horn perforator flaps. The defect areas ranged from 0.6 cm × 0.8 cm to 1.2 cm × 1.5 cm and the flap size ranged from0.8 cm×2.5 cm to 1.6 cm×4.2 cm. We put the head end of flaps at defect side. The horn perforator flap was designed with 1-2 perforator vessel and rotated to cover the defect. The defect at donor site was closed directly. We got 4 symmetric arteries in palmar and back surfaces of fingers,2 for proper palmar digital arteries and 2 for dorsal digital arteries. The proper palmar digital arteries have a larger diameter which is the main source of blood supply for fingers. All 9 flaps survived after the operation. Both the recipient area and donor areas received sound healing. With 2 months to 1.5 years of follow-up visit, the shape, color and luster, texture and function all had good healing. The horn perforator flaps for repair finger soft tissue defect have advantages of flexible design, reliable perforator vessels. The defect at donor site can be closed directly with no skin graft. This method considers both shape and function and is a good way for finger soft tissue defect.

Two Reverse Pedicle Flaps for Repairing Soft Tissue Defects of the Finger

Objective: The objective of this study was to evaluate and compare the effect of 2 reverse pedicle flaps for repairing soft tissue defects of the finger. Methods: In this prospective study, 46 patients with finger soft tissue defects planned for flap repair of soft tissue were enrolled from April 2011 to March 2015, and randomized to undergo either repair of reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery in group A (25 cases) or retrograde island flap of dorsal branch of the proper digital artery in group B (21 cases). The survive rate, hand function, postoperative complications, and appearance were compared between the 2 groups. Results: Patients were followed up for an average of 18 months in group A while 15 months in group B. All flaps in both groups survived, with satisfactory sensory function. The 2-point discrimination testing of group A was from 6.0 to 9.0 mm (7.1 ± 0.5 mm) while it was from 4.0 to 7.0 mm (5.2 ± 0.4 mm) in group B, significantly superior to that of group A ( P &lt; .05). Motion of finger interphalangeal joint in both groups was not significantly different, nor was affected in comparison with the healthy side. As for complications, 2 cases of early venous congestion and 2 cases of superficial skin necrosis occurred in group A while 1 case of flap blister occurred in group B. In addition, we observed that the appearance of the flap was 5mm higher than normal skin in 5 cases in group A, while only in one case in group B. The difference was significative ( P &lt; .05). Conclusion: Both reverse pedicle flaps were safe and reliable for repairing finger defects, while in consideration of sensory function and appearance, retrograde island flap of dorsal branch of the proper digital artery may suit better in fingertip defects repair than reversed island flap pedicled on a perforating branch of the dorsal metacarpal artery.

Differential Incidence of Cold Intolerance in Different Fingers After Performing Reverse Digital Artery Flaps for Finger Soft Tissue Defects

Objective: Cold intolerance is a common complication after the reverse digital artery flap procedure. However, we observed that the incidence of cold intolerance of different fingers was different. Therefore, we investigated the differences in the incidence of cold intolerance in different fingers and attempted to elucidate the causes of this phenomenon. Method: We recruited 37 patients and divided them into 3 groups based on injured finger, namely, 13, 13, and 11 patients for the index, middle, and ring finger groups in our study, respectively. Cold intolerance was subjectively reported by patients themselves. Our surgical procedure was designed in such a way that the reverse digital artery flap (RDAF) was located at the lateral area on the proximal phalange of the injured finger (on the ulnar side of the index, middle, and ring fingers) in consideration of patient aesthetics. Results: At final follow-up, 17 of 37 patients reported cold intolerance (index: 8; middle: 8; and ring: 1). Among the symptoms of discomfort, 9 patients mainly complained about the lower temperature of the flap upon exposure to cold weather compared with that of the uninjured area. Meanwhile, 3 patients complained of pain, and 5 patients reported numbness of the flap. The rate of cold intolerance in index, middle, and ring finger were 62%, 62%, and 9%, respectively. The patients’ age and sex did not significantly differ among the 3 groups. Significant differences were observed when we compared the incidence of cold intolerance of the index and ring fingers or the middle and ring fingers. Conclusion: Cold intolerance on the ring finger was obviously lower than intolerance in the index and middle fingers. Cold intolerance had a tendency to occur on fingers that sacrificed the dominant artery. And blood supply is an important predisposing factor for cold intolerance.

Clinical application of finger soft tissue defect coverage with dosal proximal digit fatty fasciocutaneous flap

Objective To discuss the coverage of finger soft tissue defect with dorsal proximal digit fasciocutaneous flap on the middle and distal digit. Methods From May, 2013 to December, 2014, 8 cases with soft tissue defects at 8 fingers were treated with dorsal proximal digit fasciocutaneous flap. The flap sizes ranged from 2.5 cm × 2.0 cm to 3.5 cm × 3.0 cm. The donor site were closed straightly. Results Eight flaps of 8 fingers survived. All the wounds at the donor sites healed well. Eight fingers in 8 cases were followed up for 6-12 months. The color, texture and contour of the flaps were satisfied. The two-point discrimination distances were 8-10 mm. Conclusion The skin defect in the middle and distal digit can be satisfied covered with dorsal proximal digit fasciocutaneous flap. This flap is a simple, reliable and safe management for digit defect and can be performed in the primary hospital. To ensure the surviving of the flap, ensure the surviving of the flap, the awareness of the anatomy of the flap should be known well. The limits of its reconstruction of sensation and coverage size exit in its application. Key words: Fasciocutaneous flap; Soft tissue defect of fingers; Dorsal metacarpal artery; Dorsal digit artery

TOE FIBULAR-DORSAL ARTERY FLAP ANASTOMOSED TO DORSAL DIGITAL ARTERY IN REPAIRING DORSAL SOFT TISSUE DEFECT OF FINGERS

To discuss the effectiveness of free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers. Between May 2010 and September 2015, 28 patients with dorsal soft tissue defect of fingers were treated, including 17 males and 11 females with an average age of 23.8 years (range, 15-55 years). The reasons of injuries were machine twist (15 cases), heavy pound (4 cases), the sharp cut (5 cases), and hot crush (4 cases). The time from injury to admission was 30 minutes to 12 hours (mean, 1.5 hours). The involved fingers included thumb (3 cases), index finger (8 cases), middle finger (6 cases), ring finger (6 cases), and little finger (5 cases). The area of soft?tissue?defects ranged from 2.0 cm×1.5 cm to 3.5 cm×2.5 cm, and the area of free toe fibular-dorsal artery flap ranged from 2.8 cm×1.7 cm to 3.8 cm×2.8 cm. The blood supply of the flaps were reconstructed by anastomosing the toe fibular-dorsal artery, vein, and nerve to the dorsal digital artery, vein, and nerve, respectively. The donor site was repaired by free skin graft. The operation time was 1.5-5.5 hours (mean, 2.5 hours); the blood loss during operation was 10-50 mL (mean, 30 mL). Vessel?crisis?occurred?in?1 case, and the flap survived after symptomatic treatment. The other flaps survived and the wounds healed with stage I; the skin grafts at donor site survived and the incisions healed with stage Ⅰ. Twenty-eight cases were followed up 6-24 months (mean, 8 months). The appearance of flaps was good, and two-point discrimination was 3.5-12.0 mm (mean, 5.3 mm) at 6 months after operation. The fingers function of grab and pinch recovered. According to the standard functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 20 cases and good in 8 cases, with an excellent and good rate of 100% at 6 months after operation. The donor sites of toe were smooth and had no depression. The patients had normal gait. Free toe fibular-dorsal artery flap anastomosed to dorsal digital artery in repairing dorsal soft tissue defect of fingers can obtain satisfactory effectiveness in appearance and function of fingers, and has the advantages of modified repair and less injury at donor site.

Using the special type of free tissue flap based on radial artery superficial palmar branch from palmar wrist repairing complex soft tissue defects of the digitals

Objective To investigate the clinical outcomes of repairing complex soft tissue defects of the fingers with transplantation of the special type of free tissue flap based on radial artery superficial palmar branch from palmar wrist. Methods Thirteen cases with complex soft tissue defects of fingers were repaired with free tissue flap based on radial artery superficial palmar branch from palmar wrist between March, 2012 to January, 2015. Skin and soft tissue defect 1.5 cm × 3.0 cm to 2.5 cm × 6.0 cm, accompanied by bilateral segmental artery defect and injured finger blood circulation disorder in 4 cases; with unilateral finger artery and nerve defect in 2 cases; with extensor tendon defect in 4 cases; with of the artery, nerves or tendons. The size of the skin flap was 2.0 cm × 3.0 cm-3.5 cm × 6.5 cm, and the donor site was primary closed, finger flexor tendon defect, finger artery defect in 3 cases, respectively to radial palmar superficial branch of the transverse crease of the wrist portion of the flow-through flap, carrying the median nerve of the palmar cutaneous branch of the chimeric flap, carrying palm longus chimeric flap, carrying palm longus chimeric flow-through flap to repair the wound, and defect and reconstruction. Results All the flaps survived completely, the wounds and the donor sites were healed by first intention. All the patients were followed up from 6 to 15 months (average 9.5 months). The color and appearance of the flaps were satisfactory with tender texture. The scar of donor district was not conspicuous. The twopoint discrimination of the flap was 5.5-9.5 mm (mean, 7.2 mm). According to the Chinese Medical Association Society of hand surgery of thumb and finger reconstruction function evaluation standard trial evaluation, were excellent in 11 cases, good in 1 case, medium in 1 case. Conclusion Using the special type of free tissue flap based on radial artery superficial palmar branch from palmar wrist can repair of finger skin defect, and reconstruction of the defect of digital artery, nerve or tendon tissue in one stage. It is a method for repairing complicated soft tissue defects of finger, with the advantages of shortening the course of disease and satisfied recovering of the appearance and function of the finger. Key words: Superficial palmar branch of the radial artery; Perforate flap; Digitals; Soft tissue defect; Repair

Planning digital artery perforators using color Doppler ultrasonography: A preliminary report

Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer.

Hypothenar island flap: A safe and excellent choice for little finger defects.

Soft-tissue defects of the little finger are challenging especially when bone, tendon or vascular pedicle is exposed because of trauma. The hypothenar island flap is easy to harvest and has a good colour and texture match to the little finger pulp. We present nine clinical cases of soft tissue defects of the little finger covered using the reversed hypothenar fasciocutaneous island flap. This article intends to highlight the ease of elevation and good clinical results of the hypothenar flap which is rarely used.