Clinical Analysis About Repairation Of Fingertip Defect By Great Toe Lateral Flap And Digital Artery Island Flap

There are many therapeutic methods for soft tissue defect of finger tip in handinjury,surgical flaps repairation is usually adopted generally.The recovery of feeling isthe important part of the recovery of hand function, especially for the recovery offeeling for finger pulp.This article illustrates comparative study on recovery degree offeeling after repairation the defect of skin through great toe fibular flap and reversedigital artery island flap.Objective:Evaluate the clinical effects of recovery degree of sensory nerve afterrepairation the defect of skin through great toe fibular flap and reverse digital arteryisland flap,and discuss the best surgical ways to repair the defect of skin through greattoe fibular flap and reverse digital artery island flap.Method:There are29patients who have been underwent surgical repairation thedefect of skin through great toe fibular flap and reverse digital artery island flap during2011.12-2013.02in Dalian central hospital.The patients are divided to group A and Baccording to the onset time and they have had close observation and treatment. Group Ahas16patients,they were treated by toe fibular flap.And group B has13patients,theywere treated by reverse digital artery island flap.6were injured in distal thumb,15wereinjured in distal index finger,7were injured in distal middle finger,1was injured in ringfinger.21are male and9are female.There are4got knife cut injury,9got injured bycrashing and16got ground injury.The mean age of patients was36(rang19to54years).The minimum scope of the wound is1.5cm×1.0cm and the maximum is3.5cm×1.5cm.All the wound had primary debridement and dressing change regularlyuntil necrotic tissue boundaries look clear with no signs of infection.All the patientsunderwent the selective operation with no repeated devridement.The two group have thesame preoperative preparation and postoperative treatment,including taking part infunctional exercise since2weeks after the operation and regular follow-up(6months).Evaluation for the recovery degree of feeling according to the Flap distinguishbetween two points test and sensory nerve function scale during the fellow-up.Result:The flaps are all survive well after operation.After6months,the flaps ofgroup A have satisfactory appearance,and they are not bloated. The skin of flaps havegood texture and elasticity,can anti scratch well,the two-points discrimination is4.2-5.7mm.The flaps of group B are little bloated,and have soft texture,the two-pointsdiscrimination is4.9-6.5mm.Both groups have no complication.The injured finger must has regular functional exercise and the metacarpophalangeal joint and interphalangealjoint can have normal activity after6months.The general material(number ofpatients,gender and mean age) has no statistical significance(P＞0.05),thus thecomparision can be reliable.Ater6months fellow-up, it can be summarize according tothe flap distinguish between two points test and Sensory nerve function:Group A hasbetter feeling than group B,and the differences has statistical significance (P＜0.05).Conclusion: The surgical repairation for the defect of skin by great toe fibular flaphas closer flap distinguish distance and better feeling than the repairation by reversedigital artery island flap.Free great toe fibular flap has great toe artery and nerve,canshow good appearance after operation,has soft texture and almost same with thereceptor skin,the whorl is clear and feeling well.The evaluation for healing,feeling andappearance of flap,scar and weight-bearing walking feeling of donor area aresatisfied.Therefore,great toe fibular flap has wonderful effect on surgical repairation thedefect of skin,can be generalized in clinical appilication.