| Objective:We would compare the curative effect to repairⅢ°, Ⅳ°defected nail bed by the wrap-around flaps or the reversed fasciocutaneous island flaps, and to explored the most ideal operation schemeto repairⅢ°, Ⅳ°defected nail bed in clinic.Methods:It was a retrospective analysis. There were 77 severely defected finger nail beds in 71 patients repaired by wrap-around flaps or reversed fasciocutaneous island flaps during January 2010 and December 2014 in Hand Surgery of Longganghospital 46 patients were males and 25 females. The average age of all patients was 33.80 ± 9.56 years ranging from 16 years to 60 years. 12 defected nail beds of 10 patients were operated in emergency. And 65 defected nail beds of 61 patients were performed with selective operations. All cases were randomly divided into different surgical groups. The two groups were grafting group which were repaired by wrap-around flaps and transform group which were repaired by reversed fasciocutaneous island flaps.35 patients were in the grafting group which was made up of 22 cases in 22 males and 13 cases in 13 females. While 36 patients were in the transform group which was made up of 28 cases in 24 males and 14 cases in 12 females. There was no obvious difference in preoperative preparation, rehabilitation and functional exercise in the late treat. The two groups were given anti-infection and improving microcirculation treats after surgery. And both of them were followed up for 6~48 months, average of 16 months.Compared the appearance and complication of flaps postoperative, damage on donor site, the rate of the excellent and good nails,and the recovery of movement and sensory function, and the advantages and disadvantages of wrap-around flaps and the curative effect were analysed.Results:1. The flaps oftransform and grafting group all survivaled.All flaps were not only good at appearance,no bloated,soft texture and weared resistant,but also no obvious touchpain and cold intolerance. And in the grafting group it was no influence in walking and jumping with foot. 2. In the grafting group, 6 cases appeared vascular crisis postoperative. The rate of complication was 17.14%. While in the transform group, 6 flaps were dark purple. 10 cases blistered and 1 case was part of the edge necrosis. The complication rate was 40.48%. It was statistically significant(P<0.05). 3. The evaluation of repairing nails: In the grafting group, 32 cases were the excellent nails and 3 cases were good. The nails were all excellent and good. While in the transform group, all nails were missed. 4. With reference to function evaluation trial standards of thumb and finger reconstruction of Hand Surgery of the Chinese Medical Association, the number of excellent fingers were 28, good 6, fine 1,and no bad ingrafting group. The excellent and good rate was 97.14%. While in the transform group, the number of excellent fingers were14,good 20,fine 7,and bad 1. The excellent and good rate was 78.57%.It was statistically significant(P<0.05).Conclusions: There are many advantages to repair defected finger nail bed withwrap-around flaps,such as less complications, good blood supply, perfect appearance, well recovered in movement and sensory function, and less damages on donor site. It can improve the quality of patients after operation. Consequently,it is the best operation scheme in clinical for the patients whose nail bed are Ⅲ°, Ⅳ°defected at the present stage and worthy promoting. |
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