[Repair of finger pulp defect with transverse digital palmar island flap]

Lun Qian, Quanrong Zhang, Yongjun Rui, Kuishui Shou, Mingyu Xue, Quan Wu
Chinese Journal of Reparative and Reconstructive Surgery 2009, 23 (10): 1164-6

OBJECTIVE: To investigate the method and clinical outcomes of repairing the skin and tissue defect of the finger pulp with transverse digital palmar island flap.

METHODS: From August 2007 to September 2008, 9 patients with skin and tissue defects of the finger pulp were treated, including 6 males and 3 females aged 18-48 years old. The defect was caused by crush injury by machine in 6 cases, pressure injury by heavy objects in 2 cases, and abrasion injury by grinding wheel in 1 case. The defect was located in the index finger in 4 cases, the middle finger in 2 cases, the ring finger in 3 cases, the proximal phalanx in 1 case, the middle phalanx in 7 cases, and the distal phalanx in 1 case. The defect size ranged from 1.3 cm x 1.0 cm to 2.5 cm x 1.5 cm. The defect was complicated with unilateral blood vessel and nerve defect in 8 cases, bone fracture in 2 cases, and tendon exposure in 5 cases. The time between injury and hospital admission was 20 minutes-14 hours. Transverse digital palmar island flaps (2.0 cm x 1.2 cm-4.0 cm x 1.7 cm) were used to repair the soft tissue defect during operation. The donor site was repaired with full-thickness skin graft.

RESULTS: All the flaps and skin graft at the donor site survived uneventfully. All the wounds healed by first intention. Nine patients were followed up for 6-17 months. The appearance of the flaps was similar to that of the uninjured side, there was no occurrence of obvious pigmentation and scar contracture, and the two-point discrimination value was 8-11 mm. According to the function evaluation standard for the replantation of severed finger by Chinese Medical Association Hand Surgery Academy, 8 cases were graded as excellent, 1 as good.

CONCLUSION: Repairing the skin and tissue defects in the finger pulp of middle and distal phalanx with transverse digital palmar island flap can simplify the operation procedure, reduce the suffering of the patient, and provide satisfying therapeutic effect.

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