Clinical Study On The Treatment Of Fingertip Skin Defect By Homodigital Flaps

Objective:1、To understand refers to the anatomical characteristics of thefingertip soft tissue2、Understanding V-Y advancement flap, homodigital neurovascularretrograde island flap, homodigital neurovascular antegrade island flap,homodigital reverse fasciocutaneous flap, and to provide a good treatmentsMeterlals and Methods: From January2013to June2013,We use4kindsof flap to repair fingertip defect (including thumb),respectively, with V-Yadvancement flap, homodigital neurovascular retrograde island flap,homodigital neurovascular antegrade island flap and homodigital reversefasciocutaneous flap,42cases obtained satisfactory curative effect torepair skin defect in the fingertip.Among them,42patients with46refer to(35male and11female) average age of40(range,8to60).46injuredfingers are involved in this study, including6thumbs,20index fingers,11middles，6rings and3small fingers. The skin defect area with an averageof10.0mm×8.5mm(5.0mm×6.0mm~12.0mm×15.0mm).Among the abovecases, who are all emergency cases,including explosive injury in1case,frozen in1case,cutting injury in15cases,crush injury in6 case,objection crush injury in19cases. All the fingers are associated withdistal phalangeal exposure or partial defect after debridment.Among thosefingers, there are8fingers with bone defect distal to the tuberosity,13withbone defect distal to the midpoint,15without distal phalangeal defect and10with partial nail plate or nail bed defect.Among them,22cases aretreated with V-Y advancement flap,6cases with homodigitalneurovascular retrograde island flap,11cases with homodigitalneurovascular antegrade island flap, and7cases with homodigital reversefasciocutaneous flap. Postoperatively plaster external fixation areutilized,to prevent excessive and involuntary flexion with children refers tothe blood supply of the flap to influence.postoperative close observationflap blood supply situation(skin temperature,skin colour,swelling,venousreflex),dark purple color,such as a flap can be dismantled,several needlestitching,can alleviated.According to the Chinese Medical Association in to upper part of thefunction evaluation trial standard[5]: no abnormalities,feel and function ofnormal or basic normal for optimal;mild-to-moderate deformity,sensoryand motor functions most normal or part of the normal good;deformity,sensory and motor functions is poor.Results:With follow up for3~6months postoperatively,46cases aresurvived in the first phase,including2cases with distal fingertip flap blackand hard part necrosis.the necrosis of skin flap through to remove drypart,keep soft tissue to grow after granulation tissue to cover the wound.8 cases skin flap appear dark purple color,swelling and venous crisis,bleedthe heparin anticoagulation,intermittent small incision,raise the limb,theoven to keep warm,removed stitches after symptomatic treatment,8cases offlap were improved.46casses flap texture soft better appearance,colorsimilar to the surrounding normal skin,restore protective feeling,allfingers function basic normal,qualified for daily work. According to theChinese medical association in to upper part of the function evaluation trialstandard[5]:optimal:33cases,medial:9cases,poor:4cases.Concluslons:V-Y advancement flap, homodigital neurovascular retrogradeisland flap, homodigital neurovascular antegrade island flap, andhomodigital reverse fasciocutaneous flap are four kinds of flap to repair theadult fingertip defect (including thumb) a goog choice.