| Objective:To investigate the best operative method for repairing defects of finger tip, we evaluated the functional recovery of finger tip defects which were repaired by cross finger flap or by reverse dorsal digital island facial flap.Methods:Form January2009to June2011,88finger tip defects in80cases were repaired by skin flaps in Hand Surgery of Pu Ai hospital of Wuhan City. There were55males and25females with an average age of37.83years ranging form18years old to60years old. Emergency operations were performed in72cases of78finger tip defects. Selective operations were performed in8cases of10finger tip defects. The Flap measured1.5cm×1.5cm-2.5cm×2.0cm and the length of pedicle was1.2～2.2cm. Randomly divided into two groups by the different surgical methods, there were control group which was treated by cross finger flap and observation group which was treated by reverse dorsal digital island facial flap. The control group was made up of38cases which included27males of29finger tip defects and11females of13finger tip defects, while the observation group was made up of42cases which included28males of30finger tip defects and14females of16finger tip defects. Based on the features of blood supply of the dorsal skin of the finger, the reverse dorsal digital island facial flap was designed on the proximal phalanx at the lateral midline, the axial point was designed on the ulnar or the radial dorsum of the distal interphalangeal joint. The axis was paralleled to the longitudinal axis of finger. The dorsal branch of the proper digital nerve in the flap was sutured to the end of the proper digital nerve of injured site.Three weeks after the operation the patients were given the same package (same composition) of the drug. Herbal fumigation supplied by Orthopaedic Hospital of Wuhan City was used to fumigate and wash the surgical area according to the doctors’suggestion. All the patients did effective functional exercises.Three months later, we observed the difference of functional recovery of fingertip defects between the two groups, then we compared the operation time, the hospital stay, the hospital charges and functional recovery of finger tip defects between them.Results:①. All flaps survived completely, The patients were followed up for6to24months with an average of13.6months. Fingertips of the observation group after reconstruction had good appearance, normal color, soft texture and wear-resistant. Patients didn’t complain of touch pain or cold intolerance. Static two-point discrimination was4.0-6.5mm. The activity of distal interphalangeal joints was normal. According to the hand functional evaluation standard, the results were excellent in25cases, good in19, fair in2, with95.7%overall excellent and good rate; Fingertips of the control group after reconstruction had good appearance, normal color, soft texture and wear-resistant. Patients didn’t complain of touch pain or cold intolerance. The activity of distal interphalangeal joints was limited. Static two-point discrimination was5.5-10.3mm. According to the hand functional evaluation standard, the results were excellent in10cases, good in24, fair in8, with80.9%overall excellent and good rate. The hand functional evaluation was significantly different between the observation group and the control group3months later (P<0.05);②.The general information (cases, sex, average age, et) was no significant difference between the observation group and the control group (P>0.05);③. The operation time of the observation group was (40.52±3.59) minutes, while the operation time of the control group was (40.16±4.14) minutes. The operation time was no significant difference between the observation group and the control group (P>0.05);④.The hospital stay of the observation group was (7.15±0.76) days,while the hospital stay of the control group was (10.81±1.69) days. The hospital stay was significant difference between the observation group and the control group (P<0.01);⑤. The hospital charges of the observation group were (0.97±0.10) ten thousand yuan, while the hospital charges of the control group were (1.18±0.14) ten thousand yuan. The hospital charges were significant different between the observation group and the control group (P<0.01).Conclusion:"Reverse dorsal digital island facial flap" is an effective, scientific and fairly high clinical value to repair defects of finger tip.All in all:Reverse dorsal digital island facial flap is better than Cross finger flap to repair defects of finger tip. The operation does not damage the major artery and nerve of the wounded finger. It is simple, safe, short course and can be done at one setting. It does not interfere with the function of other digits. The sensation of the reconstructed fingertip can be satisfactorily recovered. Herbal fumigation can improve the function of the hand After surgery. It is not only effective, but also cheap.So herbal fumigation is worthy to be promoted widely. |
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