Clinical Research Of Improved Abdominal Tubular Skin Flap For Repairing Whole-finger Degloving Injury Of Single Finger

Objective: Finger degloving injury can be seen frequently in Clinical, reparing it has been difficult up to now, and there has been not one best way to resolve this problem. Reasonable patients were selected and divided into two groups, the fingers of patients in control group were repared with abdominal tubular skin flap prothesis, and the fingers of patients in the other group were repared with improved abdominal tubular skin flap prothesis. Then some factors were observed such as blood flow of the flap, recovery of sensory function of the injured finger, and so on, and the more excellent surgical was selected. Thus, a new thought was provided for clinical treatment of fingers degloving injury.Methods: From March 2009 to March 2010, ten patiens with whole -finger degloving injury of single finger in our hospital were selected and divided into two groups. there were five patiens in each group.In control group: all patients were operated by traditional modus operandi.The injured fingers were debridemented entirely under local anesthesia, the injured tissue also repaired around the injured finger, in this way,?tissue of wound vicinity was normal healthy. The size of abdominal flap was selected and cutted with u-shaped at the intersection point between medioclavicular line and umbilicus line at the same side of injured finger, and axial line of flap should be fitting with injured finger. Deep fascia layer and adipose layer were reserved or not depent on the thickness of abdomen skin.After sufficient hemostasis, the full-thickness of tubular skin flap and donor area were sutured, tubular skin flap and recipient area were sutured after injured finger was intervened skin tube.The Ipsilateral limb was fixed to body in order to pedicle of skin tube did not get wrinkles. Clamping text and flap pedicle severed surgery were carried out respectively at day 14 and 28 after surgery.Blood supply of Flap was observed at day 1,2,3,7,14 after surgery ,the time of Capillaries-filled was observed at day 1,2,3,7,14 after surgery and day1,2,3,7,14,30 after pedicle severed surgery, sensory function of injured finger was assessed at month2,4,6 ,8after pedicle severed surgery.?In experiment group, all patients were operated by improved operation method.The incision,which shape looked like"—"was selected at the intersection point between medioclavicular line and umbilicus line at the same side of injured finger and was cutted vertically with injured finger.Fat pellet was eliminated with microscopic scissors and subdermal vascular plexus was reservesed. The flap was made as subdermal vascular plexus flap, which proportion of the length and width will be added. Injured finger was insertted into the bagged flap then?liftted?upward in order to contact areas and they were sutured by cotton-padded mattress type, stitch length was about two centimeters. Shape of abdominal skin flap surrounded injury finger was formed while three sides of flap pedicle connected with abdomen. The rest of operation was the same as the control group,s.Results: The flap blood supply of ten patients with whole-finger degloving injury of single finger was normal. there was no blob-shaped necrosis at the end of flap.Some phenomenon,such as flap swelling, exudate,emerged after surgery,but no infection,the exudate gradually reduced or disappeared at the day 7 after surgery, compared with the experiment group,the above of the chage was more serious in the control group. Stitches were dismantled at the second week after surgery.The skin at flap pedicle of one patient was ulcerated in control group at the second week after surgery. It could still primary healing by repairing after the second surgery. Capillary filling time of the flap between the two groups was compared at the day 1, 2, 3, 7, 14 after first operation and the day 1, 2, 3, 7, 14, 30 after the second surgery. Capillary filling time of the flap in the experiment group significantly shorten than that in the control group during the postoperative days (P<0.05). Recovery of sensory function of the injured finger was evaluated by The feeling functional recovery grading evaluation criterion which was put forward by British Medical Research Council (BMRC).Sensory function of the injured finger of all the patients had been not recoveried until postoperative two months,and until postoperative four months,sensory function of the injured fingerof two patients in control group were recoveried to the degree S1, the rest three were recoveried to the degree S2, and that of all patients in experiment group were recoveried to the degree S2.?At the postoperative six months, sensory function of the injured finger of all patients in control group and one patient in experiment group were recoveried to the degree S2, and that of the rest four patients in experiment group recoveried to the degree S3. At the eighth months of postoperation, sensory function of the injured finger of all patients in control group and two patients in experiment group were recoveried to the degree S3, and that of the rest three patients in experiment group recoveried to the degree S3+.Conclusions: Improved abdominal tubular skin flap provided the better integrity of abdominal skin,increased width of flap,s pedicle,helped formation of blood circulation at the arly stage, reducing the flap,s thickness, didn't need to repair thinner again, fingers appearance well, avoided fingers bloated cause joint activities did not reach the designated position. Direct exposure of dermis layer was beneficial for repairing of sensory function of injured finger because nerve fibers enter into easily neural receptors.Compared traditional abdominal tubular skin flap, the improved abdominal tubular skin flap was an ideal way for repairing whole-finger degloving injury of single finger.