[Repair of finger deep burn with different kinds of skin flaps].

OBJECTIVE: To investigate an effective method in clinical application of using different kinds of skin flaps for repair of the finger deep burns.

METHODS: The groin skin flap, the paraumbilical skin flap, the volar digital advancement flap, the island flap from the dorsum of the index finger, the lateral digital neurovascular island flap, and the island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum were employed to repair 157 fingers in 101 patients (78 males, 23 females, aged 12-56 years, averaged 34.6 years) from January 1997 to December 2006. Of the 101 patients, 37 had a deep partial thickness burn involving 59 fingers, and 64 had a full thickness burn involving 98 fingers. The soft tissue defects ranged in area from 1.0 cm x 1.0 cm to 6.5 cm x 6.0 cm. The interval between the injury and the operation was 4 hours to 5 days in 89 patients, and 18 to 27 days in the other 12 patients who also had infected wounds. The flaps ranged in size from 1.2 cm x 1.2 cm to 7.8 cm x 6.5 cm. The donor site was directly sutured in 84 patients, and the donor site was covered by a full thickness skin graft in the other 17 patients.

RESULTS: After operation, 98 patients had an incision healing by first intention and the flaps survived well; the other 3 patients had congestion and necrosis in the flap edges, and had a delayed healing after the dressing changes. All the donor sites had a healing by first intention. The follow-up of all the patients for 2-24 months averaged 6.5 months revealed that 9 patients, who had been given the paraumbilical skin flap, had a fat and clumsy finger; 14 patients, who had been given the groin skin flap, also had a fat and clumsy finger; 3 patients developed congestion and necrosis at their edges. The remaining patients had a satisfactory survival of the skin flaps and a normally-shaped finger. The flaps had a good appearance, with the two-point discrimination of 5-10 mm, the good finger motion ability, and the satisfactory finger appearance.

CONCLUSION: The volar digital advancement flap, the island flap from the dorsum of the index finger, the lateral digital neurovascular island flap, and the island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum are good skin flaps for repair of the finger deep burns. The groin skin flap and the paraumbilical skin flap are also good skin flaps for repair of the deep burns of the mutiple fingers but the postoperative finger may become a bit fat and clumsy.