Chen Chao, Zhang Wenlong, Tang Peifu
The Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, PR China.
Hand Surgery Department, The Second Hospital of Tangshan, Tangshan, Hebei 063000, PR China; Affiliated Hospital of North China Coal Medical College (Hebei United University), Tangshan, Hebei 063000, PR China.
Injury. 2014 Apr;45(4):805-12. doi: 10.1016/j.injury.2013.11.002. Epub 2013 Nov 13.
The common source for reconstruction of soft tissue defects of the fingers is either the same finger or the adjacent finger. However, when the donor areas are damaged by concomitant injuries, these options are not available. The purpose of this study was to report on reconstruction of these complex digital injuries using the dorsal digito-metacarpal flaps (DDMFs) and to evaluate the efficacy of this technique.
A retrospective study was conducted with 24 patients who had their fingers reconstructed using the DDMF from April 2009 to September 2011. The patients were divided into two groups based on the flow direction of the blood supply. Among them, nine patients had their fingers reconstructed with the direct DDMFs. Fifteen patients underwent tissue reconstruction in the distal phalanx with the reversed DDMFs.
At a mean follow-up of 20 months (range, 18-24 months), the mean static two-point discrimination on the flaps was 8.3 mm (range, 7-10 mm) in the direct DDMF group and 10.4 mm (range, 9-14 mm) in the reversed DDMF group, with a significant difference (P=0.001). The range of motion of the donor fingers was similar to that of the opposite hands. According to the Michigan Hand Outcomes Questionnaire, 11 patients were very satisfied, 10 were satisfied and three were neither satisfied nor dissatisfied with functional recovery of the reconstructed finger.
The DDMF is an additional option for coverage of a soft tissue defect of the finger when the commonly used local and regional flaps are not feasible.
NCT 01927003.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic/IV.
手指软组织缺损重建的常用供区是同一手指或相邻手指。然而，当供区因合并伤而受损时，这些选择就不可行了。本研究的目的是报告使用指背掌骨皮瓣（DDMFs）重建这些复杂手指损伤的情况，并评估该技术的疗效。
对2009年4月至2011年9月期间使用DDMFs重建手指的24例患者进行回顾性研究。根据血供的流向将患者分为两组。其中，9例患者采用直接DDMFs重建手指。15例患者采用逆行DDMFs进行远节指骨的组织重建。
平均随访20个月（范围18 - 24个月），直接DDMF组皮瓣的平均静态两点辨别觉为8.3 mm（范围7 - 10 mm），逆行DDMF组为10.4 mm（范围9 - 14 mm），差异有统计学意义（P = 0.001）。供指的活动范围与对侧手相似。根据密歇根手功能结果问卷，11例患者对重建手指的功能恢复非常满意，10例满意，3例既不满意也不不满意。
当常用的局部和区域皮瓣不可行时，DDMF是覆盖手指软组织缺损的另一种选择。
NCT 01927003。
研究类型/证据水平：治疗性/IV级。
