Comparisons Of The Clinical Efficacy Of Three Kinds Of Island Flap In Repairing Defect In Distal Thumb

Objective:The function of thumb accounts for about 50%of the function of a hand. The soft tissue defects in distal thumbs caused by a variety of reasons,are very common in clinical works and are generally covered by pedicled skin flaps and adjacent finger flaps.Both of those two treatments have their advantages and disadvantages.As donor site,the dorsal skin of hand(finger) is soft and thin,abounds in vascular nets and cutaneous nerves,can provides a large size of flap which easily transferred to the distal thumb.So the dorsal hand island flaps are often used to repair the defects in distal thumbs.As early as in 1960s,anatomists did systemic studies on dorsal artery in hands.Foucher first reported the application of the first dorsal metacarpal artery island flap in restoring skin and soft tissue in thumb in 1979.Subsequently,scholars at home and abroad developed continuously various kinds of dorsal metacarpal island flaps.Each kind of dorsal metacarpal island flap has its own anatomical basis,advantages and disadvantages.To apply different island flaps to repair the defect in distal thumb and compare the clinical efficacy of various methods.Methods:39 cases of defect in distal thumb were collected during 2007.4-2008. 12,male 31,female 11,22 twist by machine,11 by incision,4 by explosion and 2 by electric saw.In all these defects caused by trauma,24 patients had volar defect area bigger than dorsal and 13 in opposite,2 patients had bigger ulnar defect than radial.The area of defect from 2.0cm×1.0cm--4.0cm×2.0cm.5 patients were performed first dorsal fingerweb island flap(male 4,female 1).13 were applied dorsoulnar flap of the thumb(male 9,female 4),21 dorsal index finger island flap (male 17,female 4 ).Flap area:min 2.5cm×1.cm5,max 4.5cm×2.5cm.34 patients were repaired in one-stage and 5 in two-stage.Result:All the flaps of 39 cases were survived.21 cases were followed up 1-8 months without two-stage thinning.All flaps have moderate tissue thickness, good texture,color and cold-resistance without ulcer(because of frostbite).1 case appeared index finger extensor tendon adhesions,no first fingerweb's contracture deformity happened,no joints' activity limitation caused by scar- hyperplasia.By long-term follow-up(with no accompanying nerve),2-point distinguish sensation recovery of first fingerweb dorsal flaps are 8.9-14.3mm,dorsoulnar flap of the thumb are 7.4-11.6mm,index finger dorsal flaps are 9.1-14.7mm.Conclusions:As mentioned above,the applications of dorsal first fingerweb island flap, dorsoulnar flap of the thumb and dorsal index finger island flap in repairing defects of the distal thumb has reliable blood supply,large region can be cut, simple anatomy.As flap is close to the recipient area,there are less injury of the...