The Design Of Experiment And Clinical Application About Dorsal Digital Nerves Fasciocutaneous Reverse Flap With Dorsal Digital Vein To Repair The Amputated Finger With Shin And Vessel Fefected

Objective: To explore the method of operation and the effect of clinicalapplication about dorsal nerves fasciocutaneous reverse flap to repair theamputated finger.Hand is the most dexterous organ in mankind, it not onlyhave subtile motion and sensitive sensation but also is the exceptiveimplement creating the human civilization.With the development of epoch,human is gradually boosted in esthetic sense, so favorable appearance of thehand is becoming more and more considerable. Hand is a working organ and itis unavoidable to be injured. Complicated injured hand-amputated fingerwith shin and vessel fefected is becoming a formidable issue. The orthodoxmethod of repairing it is Stump-repaired bones of fingers decurtated toreplanlation and so on. But these methods are hard to satisfy thepatients'requirement in finger appearance and function. In recent decade years,venous skin flap is used in clinic which keeps the injured fingers' apperearnceand extent maximatily. But survival rate and survival quality of venous flap isalso the capital issue. We find it is possible to application dorsal digital nervesand dorsal nerves fasciocutaneous reverse flap with dorsal digital veinthrough investigate anatomy of dorsal vein and dorsal digital nerves, Ploting aoperation method that is dorsal nerves fasciocutaneous reverse flap with dorsaldigital vein to repair the amputated finger with shin and vessel fefected offer anew method to to repair the amputated finger with shin and vessel effected inclinic.Methods:1Anatomical study1.1Subject: We choose5upper limb types provided by anatomy facility ofHebei medical university.We dissect the skin from palm manus and finger tofingernail,recording intimating disposition of dorsal digital nerve and blood vessel, and measuring caliber of blood vessel in gage.1.2Anatomical method: We make a "S" operative incision from dorsalofcarpometacarpal joints to paratelum of fingers, and cut the skin andsuperficial fascia,so veins of hypo and dorsal hand and dorsal digital isexposured, we decoherence sufficiens skin in incisal opening and act outarchitectonic of subcutaneously. We bolter carefully dorsal digital vein anddorsal digital nerve so that we can observe and measure it. Until abstraction isover, we measure and detail vein antilinear from finger paratelum tometacarpophalangeal joints and disposition of nerve in gage.The others also do so, calculate result in statistics on the basis of data.2Disign of experiment: We use a middle finger amputated for a example,by it condition of skin and blood vessel defected, we design:①index finger orring finger's dorsal nerves fasciocutaneous reverse flap with dorsal digitalvein repair the first amputated finger with shin and vessel fefected in palmaris②index finger or ring finger's dorsal nerves fasciocutaneous reverse flap withdorsal digital vein repair the first amputated finger with shin and vesselfefected in dorsal③index finger and ring finger's dorsal nervesfasciocutaneous reverse flap with dorsal digital vein allied repair the firstamputated finger with shin and vessel fefected in annuliform④index fingeror ring finger's dorsal branch of proper digital nerves fasciocutaneous reverseflap with dorsal digital vein repair the midplate amputated finger with shin andvessel fefected in palmaris⑤index finger or ring finger's dorsal branch ofproper digital nerves fasciocutaneous reverse flap with dorsal digital veinrepair the midplate amputated finger with shin and vessel fefected in palmaris⑥index finger and ring finger's dorsal branch of proper digital nervesfasciocutaneous reverse flap with dorsal digital vein allied repair the midplateamputated finger with shin and vessel fefected in annuliform.3Clinical application: A patient whose middle and ring finger were brokenby the machine,though debridement we found there was cutaneous deficiencyin first middle finger and repaired it with index finger's dorsal nervesfasciocutaneous reverse flap with dorsal digital vein. Results:1Digital dorsal vein forms three levels of vein in dorsal hand. The first levellocated in dorsal distally articulationes,the second level seat in dorsaldistallyarticulationes, the third level situate in middle of the proximate finge, itis constancy besides.2It is regularity for the antilinear of dorsal digital vein. Dorsal veinlet besidesnail bed (0.34±0.01mm), the vein in dorsal distally articulations(0.55±0.57mm), the vein in dorsal proximate articulations(0.94±1.50mm), thethird level(1.50±0.02mm).3It is regularity for dorsal digital nerve's disposition. The dorsal of thumb isdominated absolutely by ramus superficialis nervi radialis.The dorsal ofdigitus minimus is dominated absolutely by cubital nerve. Radislis ofproximate middle finger and index and a little moiety of middle finger'smidplate is dominated by superficial branch of radial nerve, midplate andparatelum of index and middle finger is dominated by dorsal branch of digitalnerve. Ulnaris of middle finger and proximum ring finger and a little moietyof dorsal midplate is dominated by dorsal branch of ulnar nerve, dorsal skin ofmiddle and ring finger'midplate and paratelum is dominated by dorsal branchof digital finger nerve.4The stem of dorsal nerve dist disciplinary. The stem of dorsal nerve fromdorsal hand is walking along dorsal finger and to stop in distal end ofproximate finger transverse striation, but it is no statistical significance inamplitude between stem of dorsal nerve and midian line of dorsal finger. Thedorsal branch of digital nerve erupt in metacarpophalangeal joint, and walkalong with proximal phalanx palmaris to proximal phalanx.and turn todorsal finger in finger transverse striation'distalis(3.80±1.81mm). The dorsaldigital vein and dorsal digital nerve both line in surface of dorsal digital fascia,and dorsal digital vein is more superficial than dorsal digital nerve.Conclusion:1The favorable blood providing of dorsal digital nerve or dorsal branch ofdigital nerve guarantee the take of skin flap. 2The affluent dorsal digital vein and its proper antilinear can satisfyrequirement of vascular anastomosis.3There is no phalanges decurtation, the appearance and quality of finger ispossessed.4Owing to skin flap contain nerve,it can protect skin flap and enhancesensorius recovery more conspicuous.5It do not demolish capital blood vessel and nerve of donor site, so its impactin donor site is little.6The skin of dorsal digital hand is similar to digital palmaris, the skin flapafter operation is favorable in appearance and abradability.7It can solve usual problem such as all kinds of amutated finger, but notrefering to thumb.8It is similar to the usual fascia island flap in cutting circumscription limitedsuch as size of skin flap and with orthfinger to recover and so on.