Shao Xinzhong, Chen Chao, Zhang Xu, Yu Yadong, Ren Dongliang, Lu Li
Hand Surgery Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
J Hand Surg Am. 2009 Oct;34(8):1474-81. doi: 10.1016/j.jhsa.2009.06.021. Epub 2009 Sep 6.
Fingertip or pulp resurfacing is a challenging reconstructive problem, as the treatment varies widely. In this study, we report the results of a dorsal island pedicle flap raised from an adjacent finger, including the bilateral dorsal digital nerves, for coverage of extensive soft tissue defect in the fingertip or pulp.
The mean defect and the flap were 3.7 x 2.2 cm and 3.9 x 2.4 cm in size, respectively. In all cases, bilateral coaptation between the dorsal digital nerves and the proper digital nerves were performed. Patient follow-up lasted 25 to 34 months (mean, 27 months). The range of motion of the injured digits was measured. Sensibility of both radial and ulnar sides of the flap in the finger pulp was evaluated by the Semmes-Weinstein monofilament test and 2-point discrimination. Satisfaction with the appearance, pain, and cold intolerance were also assessed.
All flaps survived completely with maintenance of the normal-length digit. Full motion was maintained at the distal and proximal interphalangeal joints of both the injured and donor fingers. The mean values of Semmes-Weinstein sensitivity were 4.22 g and 4.31 g on the radial and ulnar sides of the flap in the pulp, respectively. The mean values of static 2-point discrimination were 4.4 mm and 4.5 mm on the radial and ulnar sides, respectively. All patients were satisfied with appearance of the fingertips.
The dorsal island pedicle flap from an adjacent finger can be used for coverage of extensive fingertip or pulp defects, with maintenance of a normal-length digit and restoration of sensation on both the radial and ulnar sides of the finger pulp. The sensation recovery of this series is superior to those dorsal island pedicle flaps previously described in the literature, which did not include incorporation of both dorsal digital nerves.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
指尖或指腹重建是一个具有挑战性的重建问题，因为治疗方法差异很大。在本研究中，我们报告了一种从相邻手指掀起的含双侧指背神经的岛状带蒂皮瓣用于覆盖指尖或指腹广泛软组织缺损的结果。
平均缺损面积和皮瓣面积分别为3.7×2.2 cm和3.9×2.4 cm。所有病例均进行了指背神经与指固有神经的双侧吻合。患者随访时间为25至34个月（平均27个月）。测量受伤手指的活动范围。通过Semmes-Weinstein单丝试验和两点辨别觉评估皮瓣在指腹桡侧和尺侧的感觉。还评估了患者对外观、疼痛和不耐寒的满意度。
所有皮瓣均完全存活，手指长度保持正常。受伤手指和供指的远侧和近侧指间关节均保持完全活动度。皮瓣在指腹桡侧和尺侧的Semmes-Weinstein感觉平均分别为4.22 g和4.31 g。静态两点辨别觉平均分别为4.4 mm和4.5 mm。所有患者对指尖外观均满意。
相邻手指的岛状带蒂皮瓣可用于覆盖广泛的指尖或指腹缺损，保持手指长度正常，并恢复指腹桡侧和尺侧的感觉。本系列的感觉恢复优于文献中先前描述的未包含双侧指背神经的岛状带蒂皮瓣。
研究类型/证据水平：治疗性IV级。
