[Repair of complicated degloving injuries of opposite finger with akin united flaps pedicled with dorsal carpal branch of ulnar artery]

Yunkang Yang, Xiaobo Lu, Zhongjie Zhang, Jianhua Ge
Chinese Journal of Reparative and Reconstructive Surgery 2011, 25 (2): 202-5

OBJECTIVE: To evaluate the clinical efficacy of akin united flaps pedicled with dorsal carpal branch of ulnar artery in repairing complicated degloving injuries of the opposite fingers.

METHODS: Between August 2005 and August 2009, 11 cases of complicated degloving injuries of single finger were treated, including 8 males and 3 females with an average age of 26 years (range, 19-55 years). The defect locations were thumb in 1 case, index finger in 7 cases, and middle finger in 3 cases, including 9 cases of mechanical injury and 2 cases of traffic accident injury. The extent of skin avulsion was the proximal segments or beyond the middle segment of finger with a defect range from 5.0 cm x 4.5 cm to 8.0 cm x 5.5 cm. Complicated injuries included phalangeal fracture in 2 cases, extensor tendon injury in 3 cases, flexor and extensor tendon injuries in 1 case, digital vascular injury in 9 cases, and digital nerve injury in 6 cases. The time from injury to operation was 2-18 hours (mean, 4.8 hours). The akin united flaps were designed on the basis of anatomical distribution of the dorsal carpal branch of ulnar artery. The proximally pedicled flaps enclosed palmar finger, and the distally pedicled flaps enclosed dorsal finger. The size of flaps ranged from 10 cm x 3 cm to 16 cm x 3 cm. The donor sites were sutured directly. After 3 weeks, the pedicle was cut.

RESULTS: Light yellow secretion and eczema on the flap were observed in 1 case at 3 days, were cured after 2 weeks of dressing change; other flaps survived and healing of incisions by first intention was achieved. The incisions at donor sites healed by first intention. The secondary plastic operation was performed in 2 cases because of bulky flaps at 3 months after operation. Eleven patients were followed up postoperatively 6-12 months (8 months on average). The texture and appearance of all the flaps were satisfactory. The two-point discrimination was 12-20 mm with satisfactory recovery of finger function at 6 months after operation. According to Jebsen standard, the results were excellent in 8 cases, good in 2 cases, and poor in 1 case.

CONCLUSION: With reliable blood supply, easy dissection, less injury at donor site, and good repair results, the akin united flaps pedicled with dorsal carpal branch of ulnar artery is a good method to repair complicated degloving injuries of the opposite fingers.

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