Clinical Research Of Free Finger Pulps Replantation And Reconstruction

Objective:To explore the replantation of injured free finger pulps and the reconstructionmethods of finger pulp defects, and compare the clinical effects of all thereconstruction methods.Material and Methods:To sum up53cases finger pulp damages or defects in our hospital from2004to2014, including the finger pulps replantation7cases, V-Y advancing flaps18cases, ilioinguinal skin flaps4cases, reverse digital artery island flaps6cases,thenar fascia flaps5cases, cross finger flaps11cases, and the free flaps takenfrom the fibular side of the great toe2cases, and follow-up6to24months，mean11months, then compare clinical effects of all these methods.Results:51fingers survived completely, and2cases of thenar fascia flaps survivedpartly in53cases of replantation and reconstruction of finger pulps injured，andthe wounds retarded to heal after changing gauze. After the operation,1case of thefree flap taken from the fibular side of the great toe,1case of reverse digital arteryisland flaps, and2cases of V-Y advancing flaps showed vascular crisis. We tookoff their part stitches to drain and decrease the tension of the flaps, and the bloodsupply were back to normal after treatment, and they finally survived successfully.The other of replanted and reconstructed finger pulps survived successfully. These cases were followed up for6to24months, an average of11months. Six monthsafter the operation, the mean distance of two-points discrimination(2PD)（X±s)and the excellent and good rate（%）of the finger pulps which werereplanted and reconstructed by six kinds of flaps: the finger pulps replantation4.61±0.27mm,100.0%, V-Y advancing flaps5.72±0.36mm,83.3%，reverse digitalartery island flaps7.22±0.32mm,83.3%, thenar fascia flaps7.52±0.45mm,80.8%,cross finger flaps7.44±0.42mm,81.8%, the free flaps taken from the fibular sideof the great toes5.25±0.21mm,100.0%, ilioinguinal skin flaps13.1±3.17mm,25%.Conclusions:First, the finger pulp is taken as a sensitive area that human contact with theoutside world, and should try to be replanted or perfect to be repaired when itdamages. Second, there are many reconstruction methods when the finger pulpsinjury,and we should carry on comprehensive choice according to patients’ age、sex、occupation、the similarity of the tissue to the finger pulp、the donor site lesionand the microsurgery technique level of the surgeons. Third, the finger pulpswhich were repaired and reconstructed by the free flaps taken from the fibularside of the great toes transplantation achieves realistic effects whether on theirappearance, texture, feeling or on their blood supply, so free flaps taken from thefibular side of great toes transplantation should be taken as the first choice for thereconstruction of the finger pulp.