Chen Chao, Tang Peifu, Zhao Gang
The Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, PR China.
Hand Surgery Department, The Second Hospital of Tangshan, Tangshan 063000, Hebei, PR China.
Injury. 2014 Dec;45(12):2013-7. doi: 10.1016/j.injury.2014.08.030. Epub 2014 Aug 20.
Reconstruction of soft tissue defects in fingers continues to be a challenging problem. The purpose of this study is to report the reconstruction of small-to-moderate defects of fingers with dorsal digital island flap (DDIF) and to evaluate the efficacy of use of the flap.
Over last six years, a retrospective study was conducted with 65 patients who had soft tissue defects of fingers treated with the DDIF. Sixty-nine soft-tissue defects were found in 69 fingers in 65 patients. Based on the flow direction of blood supply, the patients were divided into two groups: the direct (n=35) and reversed (n=30) DDIF groups. In addition, based on the different donor sites, the direct DDIF group was divided into two subgroups: the proximal phalangeal direct DDIF subgroup (n=16) and the extended pedicle direct DDIF subgroup (n=19). The main outcomes were static 2-point discrimination and Semmes-Weinstein monofilament scores of flap and joint motion.
At the final follow-up, the mean static two-point discrimination of the flaps was 9.7mm (range, 8 to 12mm) in the proximal phalangeal direct DDIF subgroup and 8.3mm (range, 7 to 11mm) in the extended pedicle direct DDIF subgroup, with a significant difference (p=0.005). In the direct DDIF group, there was no significant difference in total active motion between the donor fingers and the opposite sides. In the reversed DDIF group, the mean total active motion of the donor fingers was 170° and the data of the opposite sides was 181°, with a significant difference (p=0.024). Maximum amplitude losses of 15° were seen in 12% of patients in the distal interphalangeal joint.
The DDIF is reliable and technically easy for reconstructing small-to-moderate defects of fingers. The extended pedicle direct DDIF may be an optional solution when sensory reconstruction is needed.
手指软组织缺损的修复仍然是一个具有挑战性的问题。本研究的目的是报告应用指背岛状皮瓣（DDIF）修复中小面积手指缺损的情况，并评估该皮瓣的应用效果。
在过去六年中，对65例接受DDIF治疗手指软组织缺损的患者进行了回顾性研究。65例患者的69根手指存在69处软组织缺损。根据血供流向，将患者分为两组：顺行（n = 35）和逆行（n = 30）DDIF组。此外，根据不同的供区，顺行DDIF组又分为两个亚组：近节指骨顺行DDIF亚组（n = 16）和延长蒂顺行DDIF亚组（n = 19）。主要观察指标为皮瓣的静态两点辨别觉、Semmes-Weinstein单丝试验评分以及关节活动度。
在末次随访时，近节指骨顺行DDIF亚组皮瓣的平均静态两点辨别觉为9.7mm（范围8至12mm），延长蒂顺行DDIF亚组为8.3mm（范围7至11mm），差异有统计学意义（p = 0.005）。在顺行DDIF组中，供指与对侧手指的总主动活动度无显著差异。在逆行DDIF组中，供指的平均总主动活动度为170°，对侧为181°，差异有统计学意义（p = 0.024）。12%的患者远侧指间关节最大活动度损失为15°。
DDIF修复中小面积手指缺损可靠且技术操作简便。当需要感觉重建时，延长蒂顺行DDIF可能是一种可选方案。
