The 971 Hospital of the People's Liberation Army of China, Qingdao, 266071, Shandong province, China.
Qingdao Municipal Hospital, Qingdao, 266011, Shandong province, China.
Chin J Traumatol. 2024 Dec;27(6):403-409. doi: 10.1016/j.cjtee.2024.09.005. Epub 2024 Sep 14.
The reconstruction of Allen's type IV fingertip amputation is a clinical challenge. Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen's type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique.
A retrospective analysis with a 5-year follow-up including 13 patients with Allen's type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted. The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps. The operation time, intraoperative blood loss, and complications were recorded, and the survival rate of the transplanted flaps was calculated. During the 5-year follow-up after operation, the nail growth time was recorded and the finger appearance was observed. At the last follow-up appointment, the length, width, and girth of the reconstructed fingertip and contralateral normal fingertip, range of motion of the reconstructed fingertip and contralateral normal fingertip, Semmes-Weinstein test (for the evaluation of tactile sensation), and two-point discrimination testing results were recorded. SPSS 22.0 software was used for the statistical analysis and the data are presented as mean ± SD.
The mean operation time was (5.62 ± 0.51) h, the mean intraoperative blood loss was (34.15 ± 3.13) mL, and the survival rate of the transplanted flaps was 100%. During the 5-year follow-up, the average nail growth time was (10.14 ± 1.98) months and the average bone union time was (3.78 ± 0.91) months. The length, width, and girth of the reconstructed fingertip were (31.52 ± 3.73) mm, (17.82 ± 1.74) mm, and (59.75 ± 3.04) mm, respectively, which did not differ from those of the contralateral normal fingertip. The range of motion of the reconstructed fingertip was (12.15 ± 2.79) degrees which is different from that of the contralateral normal fingertip. The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were (0.39 ± 0.17) g and (7.46 ± 1.14) mm, respectively, which were not different from those of the contralateral normal fingertip. The average Maryland score of feet in the donor area was 87.66 ± 7.39, which was satisfactory.
Bilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen's type IV fingertip amputations with a satisfactory appearance and good sensory function.
Allen Ⅳ型指尖离断的重建是临床面临的挑战。我们团队设计了双侧不等大小的拇趾骨-甲-皮复合组织瓣，用于长期重建 Allen Ⅳ型指尖离断，并进行了一项 5 年随访的回顾性研究，旨在评估该技术的效果。
回顾性分析了 2010 年 1 月至 2017 年 1 月期间我院收治的 13 例 Allen Ⅳ型指尖离断患者，采用双侧不等大小的拇趾骨-甲-皮复合组织瓣治疗。记录手术时间、术中出血量和并发症，计算移植皮瓣的成活率。术后 5 年随访记录指甲生长时间，观察手指外观。末次随访时，记录再造指尖与对侧正常指尖的长度、宽度和周径、再造指尖与对侧正常指尖的活动度、Semmes-Weinstein 触觉测试（用于评估触觉）和两点辨别测试结果。采用 SPSS 22.0 软件进行统计学分析，数据表示为均数±标准差。
平均手术时间（5.62±0.51）h，平均术中出血量（34.15±3.13）mL，移植皮瓣成活率 100%。5 年随访期间，平均指甲生长时间（10.14±1.98）个月，平均骨愈合时间（3.78±0.91）个月。再造指尖的长度、宽度和周径分别为（31.52±3.73）mm、（17.82±1.74）mm和（59.75±3.04）mm，与对侧正常指尖无差异。再造指尖的活动度为（12.15±2.79）°，与对侧正常指尖不同。再造指尖的 Semmes-Weinstein 触觉测试平均评分为（0.39±0.17）g，两点辨别测试平均评分为（7.46±1.14）mm，与对侧正常指尖无差异。供区足部 Maryland 评分平均为 87.66±7.39，满意度较高。
双侧不等大小的拇趾骨-甲-皮复合组织瓣是一种有效重建 Allen Ⅳ型指尖离断的方法，外观满意，感觉功能良好。
