[Reverse island flap of digital artery parallel for repairing degloved injuries of fingertip]

Gangyi Liu, Zhifeng Xi, Conghu Wang, Xiuwen Zhu, Zongyi Liu, Fang Wang
Chinese Journal of Reparative and Reconstructive Surgery 2011, 25 (9): 1030-2

OBJECTIVE: To investigate the effectiveness of reverse island flaps of digital artery parallel for repairing degloved injuries of the fingertip.

METHODS: Between June 2008 and January 2010, 13 cases of degloved injuries of the fingertip were treated. There were 8 males and 5 females with an average age of 34 years (range, 19-62 years). The causes of injuries were as follow: impact and press injury in 5 cases, wringer injury in 7 cases, and crush injury in 1 case. The injured fingers were comprised of index finger in 6 cases, middle finger in 4 cases, ring finger in 2 cases, and little finger in 1 case. The size of skin and soft tissue defect ranged from 2.0 cm x 1.8 cm to 3.0 cm x 2.5 cm. Three cases complicated by fracture of the distal phalanx, 1 case by rupture of the insertion of extensor tendon, and 1 case by rupture of the insertion of flexor tendon. The average time from injure to surgery was 4 hours (range, 1 hour and 30 minutes-12 hours). Two neighboring skin flaps located in the same course of digital artery were adopted to repair defect of the fingertip. The size of proximal skin flap ranged from 1.2 cm x 1.0 cm to 2.0 cm x 1.5 cm and the size of distal skin flap ranged from 1.1 cm x 1.0 cm to 1.5 cm x 1.3 cm. The free skin grafts were used to repair the donor sites.

RESULTS: Circulation crisis occurred in 1 case at 2 hours after operation and was eliminated by interval disconnecting. The other flaps and skin grafts survived and the wounds healed by first intention. The patients were followed up 6-18 months (mean, 10 months). All flaps presented the satisfactory appearance and texture, and the flexion and extension function of wounded fingers recovered to normal. Two-point discrimination ranged from 7 to 11 mm at last follow-up. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 9 cases, good in 3 cases, and fair in 1 case with an excellent and good rate of 92.3%.

CONCLUSION: Based on the anatomical features of communicating branches of distal interphalangeal joint, two neighboring flaps located in the same course of digital artery are adopted to repair soft tissue defect of the fingertip. This surgical method is a simple and effective method.

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