Soft Tissue Defects Of Fingers Research Articles

Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger

To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury. Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise. All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor. The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.

Free posterior interosseous artery perforator flap in the treatment of finger with skin and soft tissue defect

To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap. Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function. All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good. Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.

Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap.

Reconstructing complex soft tissue defects of the finger requires both functional and aesthetic aspects. There are many free tissue transfers as suitable options for digital resurfacing. The anterolateral thigh (ALT) flap is not the first choice for reconstruction of this area because it has the disadvantage that the subcutaneous tissue is too thick; however, its use as a thinned form has yet to be described much. This study presents the flap thinning technique in the small-sized ALT flap for the finger soft tissue defect. From May 2009 to March 2018, 10 patients with complete circumferential or semicircumcision defects in the fingers underwent reconstructive procedures that included thinned ALT flap transfer. Finger soft tissue damage due to contusion trauma includes loss of skin and exposure of the bone and tendon. The flap is thinned in 2 different ways: peripheral thinning and total microsurgical thinning, which is selected based on the perforator vessel structure of the flap. The ALT flap sizes, averaging 4-9 cm wide and 6-12 cm long, were thinned to 4-7 mm. One perforator was included in the flaps with a pedicle length average of 6.1 cm. The flaps survived entirely in all patients except one with a 30% area in the distal part of the thinned ALT flap that became necrotic because of venous occlusion. Donor sites were closed primarily for all patients. No patients required secondary flap defatting. The small thinned ALT perforator flap can be an excellent option for full circumferential or semicircumferential soft tissue defects of the finger. Follow-up showed this as an excellent alternative for finger reconstruction in terms of aesthetic appearance and functional outcome.

Clinical effects of homodigital dorsal branch of the proper digital artery flap on repairing soft tissue defects of fingers.

Homodigital dorsal branch of proper digital artery flaps (HDBPDAF) have been proved to be an excellent alternative for repairing distal soft tissue defects of fingertip. This study was to evaluate the clinical effects of HDBPDAF on repairing various soft tissue defects of fingers, including thumb and multi-fingers defects. A retrospective study was conducted in 40 patients with 44 finger defects treated with HDBPDAF from August of 2014 to December of 2021. The defects were located on fingertip and finger pulp (n = 28), finger pulp (n = 10), and dorsum of fingers (n = 6) with bone, tendon or nerve exposed. The average size of the flaps was 1.9 × 3.9 cm. Semmes Weinstein monofilament (SWM) test, Static two-point discrimination (2-PD), Total active motion (TAM) scores, the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score were evaluated through long-term follow-up. Forty-two flaps survived completely and uneventfully. Partial flap necrosis was observed in two flaps because of the absence of dorsal branch of proper digital artery. No visible scar contracture and joint limitation were noticed. The mean SWM score of flaps was 4.11 ± 0.4 g. The average 2-PD of the flaps was 8.9 ± 0.9 mm. The mean TAM of injured fingers was 268.7 ± 5.2° (contralateral side: 283.2 ± 6.4°, p < 0.05). The mean DASH score value was 29.7 ± 7.9. The HDBPDAF was an optimal and reliable alternative to repair various distal soft tissue defects of fingers, despite a lower absent rate of dorsal branch.

Reconstruction of Multiple Digital Defects by Temporary Syndactylization Using a Lateral Arm Free Flap.

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects. Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers ( n = 33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed. Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months. Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

Effect of dorsal nerve fascial island flap on repairing distal soft tissue defects at the proximal segment of the index, middle, ring, and little fingers

BackgroundTo investigate the effect of the dorsal nerve fascial island (DNFI) flap on repairing finger soft tissue defects at the distal segments.MethodsFifty patients with distal soft tissue defects at the index, middle, ring, or little fingers were treated with a DNFI flap at the proximal phalanx between February 2008 and May 2018. The nutrient vascular chain around the dorsal branch of the proper palmar digital nerves served as the flap axis. The dorsal branch of the proper palmar digital arteries provided blood supply. The fascia pedicle served as the venous system. All patients were followed for 6 months.ResultsAll 50 flaps survived. The appearance, color, and texture of the skin returned to normal. The sensory function was partially restored. The two-point discrimination of the finger flap was 7–10 mm.ConclusionsThe DNFI flap at the proximal phalanges of the index, middle, ring, and little fingers is an effective surgical option. The technique has a high flap survival rate and long pedicle, which can repair different parts of the finger. The flap also restores the sensory function of the finger without damaging the main nerves or blood vessels. The flap treatment is an optimal option for finger soft tissue defects at the distal segments.

Assessment of treatment result of soft tissue defects of fingers by local pedicle flap

Background: The hands, especially fingers, are one of the nicest organs in the bodies movement system and participate in most daily activities. It performs the function of sophisticated movement and good touch. Thus, the risk of hand injury, especially digital defects is very high. Besides, the defects after removing the contracture scar, if treatment is not done well, will leave sequelae affecting the function and aesthetics of the hand. Subject and method: The uncontrolled clinical interventional study on 39 patients with 41 soft tissue defects of fingers reconstructed by the local pedicle flap in Plastic - Comestic - Hand Departement, Hue Central Hospital. Result: In 41 flaps used, there were 100% cases of flap survived, ensuring the coverage function, including 8/41 flap congested in the postoperative period, 1/41 flap infected with flap’s margin, There were no failed cases requiring additional recovery surgery. In all cases, the donor area of the flap healed well in the first stage (31/41 in cases of skin grafting in the flap, 10/41 in the cases that can be sutured to close the donor area directly). The 1-month follow-up results showed that 82.9% of flaps achieved good results, 17.1% of flaps achieved average results, there were no cases of bad results and failures. The results of the 3-month follow-up were 87.8% with good results and 12.2% with moderate results. All of the patients were satisfied with the surgical results. Conclusion: There are many options of flaps available for use in finger soft-tissue defect contouring, flexibility is needed in using flaps for each type of defect to provide the best results in terms of coverage and aesthetics. Key words: finger soft-tissue defect, local pedicle flap.

Study on clinical characteristics and outcome evaluation of cross finger flap in soft tissue defect of finger at Can Tho Central General Hospital

Background: Fingers and hand are important parts of human body and soft tissue defect of fingers are the most common form of hand injuries. There are various techniques used for reconstruction of finger defect but cross finger flap is effective and very simple procedure without significant complication or require special techniques. Objectives: To examine characteristics of clinical and to evaluate the outcomes of cross finger flap for reconstruction of soft tissue defect of fingers. Materials and methods: 22 patients who had soft tissue defect of fingers who had undergone the cross finger flap cover. We noted mechanism of injury, size of defect, size of the flap, type of cross finger flap was used. Outcome measures recorded were flap viability, flap sensibility using two -point discrimination (TPD), total active motion of fingers (TAM) and patient satisfaction.&#x0D; Results: Among 22 patients treated with cross finger flap, there were 18 men and 4 women with the average age 38.6±11.4. The most common mode of injury was industrial accident (59.1%). The mean size of the defect was 205.5±86.6mm2 (range: 110mm2-500mm2). The average TPD test measured was 7.6±1.5mm. Full range of motion was obtained in 81.8% of patients. The functional and aesthetic results were satisfactory in 95.5% patients. Conclusion: The cross finger flap is safe and effective method for reconstruction of soft tissue defect of finger. This procedure is simple to perform under local anesthesia and is able to provide both mechanical stability &amp; sensory recovery.

Dorsal Digital Artery Island Flap is an Effective Technique for Coverage of Finger Defect

Background: Reconstruction of soft tissue defects in fingers is a challenging problem and continues to evolve. A variety of flaps for reconstructing small-to-moderate defects have been described, but none is beyond drawbacks. The purpose of this study is to report and to evaluate the efficacy of the use of dorsal digital island flaps (DDIF) for the reconstruction of finger defects. Materials and Methods: The study was conducted from January 2020 to September 2021 in the Burn and Plastic Surgery Department at Rajshahi Medical College Hospital. A total of 10 DDIF, based on either proximally or distally, were done in 9 patients. Most of the causes of defects were electrical burns. All flaps survived with minimal complications to the donor finger. Results: Among 10 digits, the mean defect size was 4.24 (±2.34) cm2, ranging from 1.92 to 5.95 cm2. Defects were observed: 4 in middle fingers, 3 in thumb, 2 in ring fingers, and one in index finger. 6 fingers were in right hand. DDIF covered the defects on volar (5 cases), dorsal (4 cases), and both (1 case) surfaces. According to site, one case had defect on proximal phalanx with 3rd web space, 4 instances had on proximal phalanx, defect involving on both proximal and middle phalanx was in one case and rest 4 cases had defect on distal phalanx. Among 10 DDIF, 7 (70%) flaps were survived without any loss. Rest 3 (30%) cases had marginal necrosis (less than 2 mm loss) but did not require further procedure. Conclusion: DDIF is a reliable and effective option for finger defect coverage.

Reconstruction of Digit Soft Tissue Defects With the Fourth Common Digital Artery Perforator Flap

The hand has unique skin characteristics. Intrinsic flap donors are limited due to functional specificity and compactly connected structures. The hypothenar area is a reliable option for the reconstruction of finger defects. We performed anatomic studies elucidating the blood supply of this area and hypothesized that the fourth common palmar digital artery perforator free flap can be used to reconstruct soft tissue defects in fingers with minimal donor site morbidity. From November 2017 to February 2020, 30 procedures of fourth common digital artery perforator free flaps were performed to cover digital skin defects. A retrospective chart review was performed, and the cases were analyzed. The mean patient age was 42.4 years (range, 1-75 years; median age, 40 years). Defects were located at the fingertip (n= 12), the dorsum (n= 3), the palmar (n= 9) aspect of the finger, and both the dorsal and palmar aspects of the finger (n= 6). Indications included emergent coverage (n= 13), coverage after necrosis (n= 11), oncological resection (n= 1), and contracture release (n= 5). The defect size ranged from 1.5× 0.8 cm (1.2 cm2) to 6× 2.5 cm (15 cm2). The perforator was located approximately 1 cm proximal to the distal palmar crease as it arose from the fourth common digital artery at a right angle. It continued to the ulnar border of the hand through the superficial fasciaof the hypothenar muscles before running in a proximoulnar direction toward the dorsum of the hand. The diameter of the perforator was between 0.5 and 0.7 mm. All flaps survived. One case required a split-thickness skin graft for donor site closure, and all others could be closed primarily. The fourth common digital artery perforator is a versatile flap and can be used for both palmar and dorsal defects, including for the fingertip. The location of the perforator used differs from previous descriptions but is routinely and reliably located. Therapeutic IV.

Flow-through arterialized venous free thenar flaps for palmar soft tissue defects in fingers.

ObjectiveTo evaluate the efficacy of venous free thenar flaps for reconstructing palmar soft tissue defects in fingers.MethodsFrom December 2018 to October 2019, 11 patients with palmar soft tissue defects in fingers were treated using venous free thenar flaps. At the final follow-up, the range of thumb radial and palmar abduction on the injured side and opposite side was calculated. The total active movement (TAM) of the injured and opposite fingers and flap sensibility recovery were also recorded.ResultsThe mean follow-up time was 13.4 months, all flaps survived, and all wounds at the donor sites healed with no skin necrosis. At the last follow-up, the average range of thumb radial abduction and thumb palmar abduction on the injured side was 96.6% and 95.9% of the value on the opposite side, respectively. The average TAM of the injured fingers was 98.2% of the value of the opposite fingers. Sensation in the flaps was restored to grade S2 to S3.ConclusionVenous free thenar flaps can be alternatives for reconstructing palmar soft tissue defects in fingers.

Using Dorsal Metacarpal Artery Perforator Flap in the Soft Tissue Reconstruction of Traumatic Finger Defects: A Single-Center Study.

The reconstruction of soft tissue defects of fingers is a challenge due to the limitations of local tissue availability. The dorsal metacarpal artery perforator (DMAP) flap is a vascular island flap raised on the dorsum of the hand, and it is a good option for finger reconstruction by replacing similar-for-similar in a single operation. In this study, we would like to share our experience of using the DMAP flap in cases of various traumatic finger defects. From November 2016 to May 2019, patients who had traumatic finger injuries and had undergone DMAP flap for soft tissue reconstruction were examined. The patients' demographic data, injury and flap characteristics, wound healing status, and complications were collected and studied. The functional and aesthetic outcomes were evaluated using the Michigan Hand Outcomes Questionnaire. There was a total of 10 patients included in this study, of which 9 were male and 1 was female. The average age was 43 years (17-66 years). Seven patients were administered general anesthesia, and 3 others wide-awake local anesthesia. The average flap size was 4.9 × 2.0 cm, and all the donor sites were primarily closed. Nearly half of the patients had temporary venous congestion, but most of the flaps survived well ultimately. Only 1 patient had a partial flap necrosis, which required an additional skin graft. The DMAP flap offers a thin and pliable skin to reconstruct finger defects within 1-stage surgery. It is easy to harvest with reliable and constant circulation. With adequate design, the DMAP flap can be used to resurface both volar and dorsal finger defects and also can reach the tip of the little finger. The DMAP flap is the ideal flap for reconstruction of traumatic finger defect with either local or general anesthesia.

Comparison of therapeutic efficacy between venous flap and the flap with superficial palmar branch of radial artery in reconstruction of the defect of finger with segmental defect of proper digital artery

Objective To compare the effectiveness of venous flap and the flap based on superficial palmar branch of radial artery (SPBRA) in the reconstruction of the defect of finger with segmental defect of proper digital artery. Methods From July, 2014 to March, 2018, 40 patients with soft tissue defects of finger and the proper arteries were treated by the venous flaps (18 cases, group A) and the flaps based on SPBRA (22 cases, group B). The operative time, postoperative 2-PD of the flaps, appearance, patient satisfaction, flaps donor site complications, flaps survival rate and the motion of digital joints were observed and compared by software SPSS 17.0. P<0.05 was considered statistically significant. Results Forty flaps all survived, and the wounds healed primarily. The operative time of group A was (78.89±7.36) min, which was shorter than that of group B (97.27±9.26) min, with statistically significant difference (P 0.05). Conclusion A higher survival rate and satisfactory clinical efficacy can be achieved by the venous flaps and the flap based on SPBRA while the area of defect in hand soft tissue, where there exists a segmental defect of proper arteries, is small. In terms of the recovery of sensing, the first choice is the flap based on SPBRA. In considering of the difficulty in surgical operation, the venous flap is a relatively simple procedure. Key words: Superficial palmar branch of radial artery; Venous flap; Finger injuries; Microsurgical operation

Application of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger

Objective To explore the clinical efficacy of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger. Methods From January 2017 to January 2018, 14 patients with soft tissue defect of finger were treated. The super-thin venous flaps were harvested from the dorsal foot according to the area of finger defects. The wound was repaired by arterialization of veins. The dorsal cutaneous nerve of foot was incised in 4 cases. The donor site was sutured directly. The functional exercises were started after 2 weeks of immobilization. Results All the patients were follow-up for 6 to 12 months, 11 cases survived uneventfully, 2 cases had partial necrosis of skin flaps, and 1 case lost follow-up after 3 months. The partial necrosis of skin flaps healed after dressing change. 10 cases had two-point discrimination of 11 to 13 mm, and 4 cases with nerve in flaps had two-point discrimination of 7 to 9 mm. Conclusion It is simple and satisfactory to repair finger tissue defects with super-thin venous skin flap of dorsal foot. The donor site can be sutured directly and the sensory function can be reconstructed simultaneously with dorsal foot nerve excision. Key words: Finger injuries; Surgical flaps; Arterialized venous; Super-thin skin flap

Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger

BackgroundWhen restoring the appearance and function of the fingers, hand surgeons face a challenge in choosing a suitable surgical method to repair finger skin defects.MethodsIn this study, we designed a long elliptical flap based on a propeller perforator flap and located slightly toward the dorsal lateral aspect of the finger. The flap with a pedicle consisting of the dorsal perforator of the distal digital artery and dorsal digital artery perforator chain is rotated to cover a large wound on the distal end. From December 2014 to December 2017, 10 patients with finger soft tissue defects were treated with the propeller perforator flap described in this study.ResultsAll flaps survived after surgery, and 2 had a transient venous congestion. After a follow-up period of 3 to 12 months, the static two-point discrimination of the flap was 8.06 ± 1.75 mm, and the range of motion was 149.4 ± 12.9°. This designed flap can span several angiosomes supplied by the perforators. Due to the inclusion of a vessel chain between the dorsal digital artery perforators, the length-to-width ratio of the flap can be up to 3:1.ConclusionsThis technique increases the size of flap that can be harvested safely while retaining a reliable blood supply. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based on dorsal digital artery perforator chains.Trial registrationThe registration number of this study is ChiCTR1800014588; it has been retrospectively registered with Chinese Clinical Trial Registry (chictr.org.cn), 18/11/2019.

Repair of soft tissue defect of fingers with modified arterialized venous flap

To summarize the effectiveness of modified arterialized venous flaps in repairing soft tissue defect of fingers. Between January 2017 and April 2018, 16 patients with soft defects of fingers were treated. There were 12 males and 4 females, with an average age of 41 years (range, 24-74 years). One case was resulted from resection of cicatricial contracture and 15 cases was caused by mechanical strangulation. The defects located at thumb in 3 cases, index finger in 5 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 2 cases; and at the palmar aspect in 4 cases, and dorsal aspect in 12 cases. The size of defect ranged from 3 cm×2 cm to 10 cm×3 cm. All flaps were harvested from the palmar aspect of the ipsilateral forearm. The distal ports of the two veins were ligation. Partial fat was eliminated and the all connecting minute branches between the two veins were ligation under microscope in order to achieve the thorough shunt restriction. Then the flaps were positioned over the recipient site without inversion. The size of flap ranged from 3.5 cm×2.5 cm to 10.5 cm×3.5 cm. All donor sites were directly sutured except that 1 case was recovered with free skin graft. All flaps survived entirely except that 1 case happened vein crisis. Three flaps demonstrated mild-to-moderate venous congestion without any treatment and the swelling of flaps gradually subsided after 1 week. Skin grafting at donor site survived and all incisions healed by first intension. Thirteen patients were followed up 8-16 months (mean, 11 months). The textures and appearances of the flaps were satisfactory. At last follow-up, the mean size of the Semmes-Weinstein (SW) monofilament test of the flaps was 4.01 g (range, 2.83-4.56 g); the mean static two-point discrimination of the flaps was 12 mm (range, 6-20 mm). Modified arterialized venous flaps with thoroughly restriction of arteriovenous shunting can offer decreased congestion of venous flaps and improve survival rate. Better effectiveness can be achieved by using this flap to repair soft tissue defect of finger.

Different mini skin flaps in repairing finger soft tissue with bone defect

To explore surgical methods and clinical effects of three different types of mini skin flap transplantation for repairing finger soft tissue with bone defect. Thirty-three patients with finger soft tissue or bone defect were treated from December 2014 to October 2016, including 24 males and 9 females aged from 21 to 52 years old with an average of (36.42±5.70) years old, and soft tissue defect area ranged from 1.3 cm×1.8 cm to 2.3 cm×4.2 cm. According to damage degree, nature and patients' options, 15 finger of 15 cases were adopted retrograde dorsal metacarpal artery perforators fascia flap, 10 fingers of 9 cases were treated with free foot artery descending branch wrist skin flap, 9 fingers of 9 cases were treated with free the second toe details phalanges compound flap. Survival rate, postoperative complications and finger function assessed by Dargan functional criteria at the latest follow up were observed. All flaps were survived, both of donor site and recipient site were without deep infected. The donor site of one patient occurred necrotic, and the distal donor site of one patient occurred surface necrotic, then healed by active dressing change. All patients were followed up from 6 to 16 months with an average of(8.34±1.28) months. Two points of finger recognition were restored between 8 and 12 mm with an average of (8.84±0.43) mm, and the appearance, texture and sensory functions of skin flap were restored. No obvious complications were observed on the donor site. According to Dargan function evaluation of finger joints, 18 patients got excellent results, 14 moderate and 1 good. Three kinds of mini skin flap could receive good results in repairing soft tissue of finger or bone defect. Reverse dorsal metacarpal artery perforator fascia flap is not necessary with anastomosing blood vessels and has advantages of safe, simple and high survival rate. Descending branch of superior cutaneous branch of free ulnar artery could cut multiple other perforator flaps simultaneously, and the scar is small and hidden. Dissociated the second toe combined metatarsal phalangeal flap could repair shape and function of finger to the maximum extent and donor site is hidden.

Transposition turnover adipofacial flap for coverage of dorsal finger granuloma defects.

Summary: We are presenting a 60 year old female with left middle finger soft tissue defect involving the dorsal aspect of distal phalanx; as a result of excision of recurrent fungating granuloma mass. The patient was treated with local trans-positional adipofacial turnover flap from dorsum of same finger as a one stage procedure. This provided excellent coverage and good wound healing to resume function of finger as early as possible. The flap survival was adequate with no morbidity to the donor site.

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