Wang Bin, Jia Song, Lu Aidong, Hao Ruizheng, Huo Yongxin, Fei Xiaoxuan, Pang Haitao
Department of Hand Surgery, the Second Hospital of Tangshan (Affiliated Orthopedic Hospital of Hebei United University), Tangshan Hebei, 063000, P.R.China.
Department of Ophthalmology, Kailuan General Hospital.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1383-1386. doi: 10.7507/1002-1892.20160284.
To investigate the effectiveness of free second toe dorsal flap combined with middle or ring finger island flap for repairing degloved thumbs.
Between August 2009 and June 2013, 6 patients with degloving injury of the thumb were treated using free second toe dorsal flap combined with middle or ring finger island flap. There were 4 males and 2 females, aged 19-44 years (mean, 32 years). The left thumb was involved in 2 cases and the right thumb in 4 cases, including 5 cases of type II and 1 case of type III degloving injury. The size of wound was 5.5 cm×2.5 cm to 6.5 cm×5.0 cm. After emergency debridemented, 5 patients underwent vacuum sealing drainage and surgical repair after 3-5 days; 1 patient underwent abdominal embedding and repair after 14 days. The size of second toe dorsal flap ranged from 2.5 cm×2.2 cm to 4.2 cm×3.0 cm, and the size of middle or ring finger island flap ranged from 2.0 cm×1.5 cm to 3.5 cm×2.8 cm. Neurorrhaphy was performed between the plantar digital nerve of the second toe and the proper digital nerve at the recipient site in 5 cases, and no nerve anastomose in 1 case. All the distal phalanxes were partially excised. The donor sites were covered with free skin grafts.
All of the flaps survived completely and incision healed by first intention. Three patients had alloesthesia of the middle or ring finger island flaps. All of the 6 patients were followed up from 6 months to 3 years (mean, 23 months). The flaps had good color and soft texture, and the finger had satisfactory appearance, but the fingernails were smaller than that of normal side. The sensation of the dorsum of the second toe reached S, and the mean two-point discrimination of the pulp was 6 mm (range, 4-7 mm). According to total active movement (TAM) system, the function of the thumbs was excellent in 5 cases and good in 1 case.
A combination of free second toe dorsal flap and middle or ring finger island flap is a useful and reliable technique for reconstruction of a degloved thumb.
探讨游离第二趾背侧皮瓣联合中指或环指岛状皮瓣修复脱套伤拇指的疗效。
2009年8月至2013年6月，对6例拇指脱套伤患者采用游离第二趾背侧皮瓣联合中指或环指岛状皮瓣治疗。其中男4例，女2例，年龄19 - 44岁（平均32岁）。左侧拇指2例，右侧拇指4例，其中Ⅱ型脱套伤5例，Ⅲ型脱套伤1例。创面大小为5.5 cm×2.5 cm至6.5 cm×5.0 cm。急诊清创后，5例患者行负压封闭引流，3 - 5天后行手术修复；1例患者14天后行腹部埋入法修复。第二趾背侧皮瓣面积为2.5 cm×2.2 cm至4.2 cm×3.0 cm，中指或环指岛状皮瓣面积为2.0 cm×1.5 cm至3.5 cm×2.8 cm。5例患者将第二趾足底趾神经与受区指固有神经行神经吻合，1例未行神经吻合。所有远节指骨均部分切除。供区采用游离皮片覆盖。
所有皮瓣均完全成活，切口一期愈合。3例患者中指或环指岛状皮瓣有感觉异常。6例患者均获随访，时间6个月至3年（平均23个月）。皮瓣色泽、质地良好，手指外观满意，但指甲较健侧小。第二趾背侧感觉达S级，指腹平均两点辨别觉为6 mm（范围4 - 7 mm）。按总主动活动度（TAM）系统评定，拇指功能优5例，良1例。
游离第二趾背侧皮瓣联合中指或环指岛状皮瓣是修复脱套伤拇指的一种有效且可靠的技术。
