Clinical Application Of Using A Series Of Flaps Of Dorsum Of The Finger

Objective: To report the outcome for repair of skin defect of the fingers using the fascial island flap of dorsum of the finger, fascial island flap with dorsal branch of the proper digital artery and the cross-finger flap of ultra proportion with the dorsal branch from the proper digital artery. Three series (8 kinds) of flaps of dorsum of the finger were used to treat patients of skin defect of the fingers and follow up postoperatively. Check up the function of patient's fingers and compare with the function of patient's fingers treated by traditional flaps so as to draw a scientific conclusion, and then put forward reliable clinical application stats and guide clinical treatment.Methods: Choosing 243 patients of skin defect of the fingers (includes a part of patients of Tanshan No.2 Hospital from 1998 to 2005) and allocating two groups at random. The experimental group includes 183 patients(205 flaps). Three series 8 kinds of flaps of dorsum of the finger were used to treat patients of skin defect of the fingers. Flap type: the direct fascial island flap with digital dorsal nerve 22 cases(22 flaps); the direct fascial island flap with dorsal branch of the proper digital nerve 31 cases(31 flaps); the reverse fascial island flap with digital dorsal nerve 34 cases(40 flaps); the reverse fascial island flap with dorsal branch of the proper digital nerve 25 cases(31 flaps); three kinds of fascial island flap with dorsal branch of the proper digital artery 51 cases(61 flaps); the cross-finger flap of ultra proportion with the dorsal branch from the proper digital artery20 cases(20 flaps); Anastomosing dorsal branch of the proper digital nerve of flap with the proper digital nerve of donee 37cases, Anastomosing digital dorsal nerve of flap with the proper digital nerve of donee 21 cases. The control group includes 60 patients(60 flaps). The traditional flaps, such as cross-finger flap, abdominal wall flap, infraclivacular flap and so on, were used to treat patients of skin defect of the fingers. Checking up and evaluating the function of patient's fingers in the 4th, 8th, 16th week after the operation.(only evaluates donater)Results: One handred and seventy-four flaps survived totally. There was partial necrosis in 9 cases. The follow-up ranged from 5 months to 6 years postoperatively with a mean of 7 months. It showed satisfactory results functionally and cosmetically. There was partial necrosis in 4 the reverse fascial island flaps with dorsal branch of the proper digital never, 3 the reverse fascial island flap with digital dorsal nerve and 2 fascial island flap with dorsal branch of the proper digital artery. One handred and seventy-four flaps survived completely. The flap had good texture and color match.The two point discrimination: the direct fascial island flap with digital dorsal nerve and the direct fascial island flap with dorsal branch of the proper digital never were 8 to 10 mm with a mean of 8.5 mm; the reverse fascial island flap and fascial island flap with dorsal branch of the proper digital nerve were 8 to 10 mm in the sensate flaps in the 8th to 16th week after the operation; the reverse fascial island flap with digital dorsal nerve and the reverse fascial island flap with dorsal branch of the proper digital never were 9 to 11 mm with a mean of 10.5 mm in the nonsensate flaps; fascial island flap with dorsal branch of the proper digital artery were 9 to 11 mm with a mean of 10 mm in the nonsensate flaps; the cross-finger flap of ultra proportion with the dorsal branch from the proper digital artery were 7 to 9 mm with a mean of 8 mm in the sensate flaps. The TAM score of range of motion was 80% to 90% of the healthy side.According to the ATM standard, the results were excellent in 134 case, good in 37, fair in 12,with 94% overall excellent and good rate.Conclusions: The operation of 3 series (8 kinds) of flaps of dorsum of the finger do not damage the major nerve and artery of the finger, and the sense of flap is satisfactory . The flaps was suitable thickness softness and resistance to wear and tear. Researches of anatomy attest that the location of dorsal branches of the proper digital artery are steady, thus the flaps was good blood supply. The operation of flaps of dorsum of the finger do not effect the sensation of volar side of fingers, but can achieve the aim of reconstruction of sensation of donee. The axis of inclination of fascial island flap with dorsal branch of the proper digital artery is measured up the anatomy of dorsal branches of the proper digital artery and makes fascial pedicle of flap longer, at the same time, prevents the flap from dangerous situation brought about by vein, because it avoid the burden of veinal reverse current.The flaps for repair of hand architecture defects have its indication and clinical application value,and it is a reliable way for reconstruction of architecture defects of finger. Repairing skin defects at multiple fingers with the reverse fascial island flap is more excellent. The cross-finger flap of ultra proportion with the dorsal branch from the proper digital artery is an alternative method for repairing skin defect on the dorsal and volar side of fingers.