Clinical Effect Of Reverse Island Flap With Dorsal Terminal Branch Of Digital Artery With Dorsal Digital Nerve In Repairing Fingertip Defect

Objective: To investigate the clinical effect of reverse island flap with dorsal terminal branch of digital artery with dorsal digital nerve in repairing same fingertip defect.Methods:Retrospective analysis of the clinical effect of 19 cases(20fingers)with soft tissue defects at the same fingertip using reverse island flap with dorsal terminal branch of digital artery with dorsal digital nerve from March 2018 to September 2019 in the third Hospital of Hebei Medical University,and with the clinical effect of reverse digital artery island flap anastomosed with nerve to repair the defect of the same fingertip in 17 cases(20 fingers)was taken as the control group.According to the 6-month follow-up results,the shape,texture,color,pain,touch,static two point discrimination(S2PD),holding stability and range of motion of interphalangeal joint of the two groups were compared and analyzed,the evaluation was carried out according to the trial criteria of upper limb partial function assessment issued by the Hand Surgery Society of Chinese Medical Association.According to the evaluation standard of neurotrauma society of British Academy of medical research,the sensory recovery of pulp of two groups of flaps after repairing fingertip defect was compared and analyzed.After 12 months of follow-up,cold intolerance symptom severity(CISS)questionnaire was used to compare the cold tolerance of injured fingers between the two groups.Results:All patients were followed up for 5-14 months.The appearance and texture of the flaps in the two groups were good,the pulp of the fingers was full,there was no obvious hyperalgesia in the donor area,and the range of motion of the interphalangeal joint of the affected fingers was not significantly limited.Six months after operation.The static two point discrimination(S2PD)of flap: the observation group was 4-8 mm,with an average of 5.70 ± 1.26 mm,and the control group was 4-8 mm,with an average of 6.30 ± 1.17 mm,data of the two groups were statistically analyzed: P>0.05.Total range of motion of proximal interphalangeal joint of injured finger,the observation group was 91°-99°,with an average of 94.25±2.73°,and the control group was85°-95°,with an average of 90.35±3.10°,data of the two groups were statistically analyzed:P<0.05.The total range of motion of the distal interphalangeal joint,the observation group was 58°-78°,with an average of68.95±6.02°,and the control group was 54°-74°,with an average of64.85±6.14°,data of the two groups were statistically analyzed:P<0.05.The range of cold intolerance severity score of injured finger was followed up 1year after operation,the observation group was 6-24 points,with an average of14.60±5.77 points,all of them were mild cold intolerance,and the control group was 8-44 points,with an average of 24.60±10.40 points,among them,8fingers were moderately cold intolerance and the rest were mild cold intolerance,data of the two groups were statistically analyzed: P<0.05.According to the "trial evaluation standard of upper limb function of Hand Surgery Society of Chinese Medical Association(late examination content and evaluation standard of hand flap)",11 fingers in the observation group were excellent,8 fingers were good,the excellent and good rate was 95%,and 7fingers in the control group were excellent,9 fingers were good,the excellent and good rate was 80%.Conclusion: Compared with the traditional digital artery retrograde island flap with nerve branch,the reverse island flap with dorsal terminal branch of digital artery with dorsal digital nerve can also obtain better sensation in the treatment of soft tissue defect of the same finger tip.The operation can be completed at one time without sacrificing the digital artery and proper digital nerve.The donor site is less damaged and there is no obvious movement obstacle of interphalangeal joint after the operation and the severity of cold intolerance was also low.It is one of the alternative surgical methods to repair the fingertip defect.