Comparative Study On The Clinical Effects Of Three Kinds Of Skin Flaps In The Repair Of Thumb Pulp Defect

Objective: The function and role of the thumnb occupy about 50 percent in the hand,so It is very important to repair the skin and soft tissue defect of the thumb belly.This study uses the radial dorsal thumb cutaneous nerve nutrition blood vessels flap,dorsal skin flap of index finger and the great toe fibular free flap to repair the thumb pulp skin and soft tissue defects in 68 patients with 68 fingers.We Compare three surgical methods’ clinical efficacies in order to guide clinical practice.Methods: We choose 68 cases of thumb pulp defect who were treated in the Department of hand and foot surgery in Wudang Hospital Affiliated to Guizhou Medical University from July 2014 to July 2016.According to the order of hospitalization,the patients were randomly divided into three groups: A,B and C.We used the radial dorsal thumb cutaneous nerve nutrition blood vessels flap to treat 26 cases 26 thumbs of A group,adopt the index finger dorsal flap repair 24 cases 24 thumbs of B group and apply great toe fibular flap deal with 18 cases 18 thumbs of C group in this clinical study.There were 37 cases wiht left thumb pulp defect and 31 cases wiht right thumb pulp in this study.There were 38 males and 30 females in the all cases of 68 patients.In All casess,24 cases were caused by cutting injury,20 cases injuried by crashig objects,18 cases caused by crush injury and 6 cases injuried by chainsaw.The maximum age was 59 years and the minimum one was 19 years in the 68 cases.The wound area was from 1 centimeter multiplied by 1.5 centimeters to 2 centimeters multiplied by 4 centimeters.The time from injuring to getting to hospital was from 0.5hour to 8 hours.We adopt the corresponding surgical treatments in accordance with the grouping of patients.The follow-up time was from 6 to 12 months.The operation time and bleeding volume were recorded during operation.The follow-up items were related to the appearance of skin flap,the recovery of sensation,the late evaluation criteria of hand flap and two-point discrimination.Results: After flaps repaired,marginal necrosis of flap happened in 1 cases of B group and 1 cases of C group and there were 3 cases of flap vascular crisis occurred in C group.During follow-up,We found there were 3 cases bulky flaps in the A group,2 cases bulky flaps in the B group,but all the flaps in C group were satisfied with the appearance and no one bulky flap.There was no significant difference between the three groups in all aspects of clinical data(P > 0.05),so three groups were comparable.Among them,C group was the most satisfied in the observation indexs of the sensory recovery,the late evaluation criteria of hand flaps and two-point discrimination,however,the operation time was longest and bleeding volume was most in three groups.Conclusion:The operation time of the radial dorsal thumb cutaneous nerve nutrition blood vessels flap is the shortest and the bleeding volume of that is the least in three methods of operation.The surgical method of this skin flap is simple and it comply with the principle of transfering to the nearest.So it’s suitable to be applied in basic-level hospitals.The recovery of two-point discrimination in dorsal flap of index finger is better than the radial dorsal thumb cutaneous nerve nutrition blood vessels flap.But the real feeling of dorsal flap of index finge is poor.Some patients said that the postional feel of the flap was located in the index finger.Besides,the operation time and bleeding volume are more than that of the radial dorsal thumb cutaneous nerve nutrition blood vessels flap.So it is not considered as the preferred method to repair thumb finger pulp defect.So it is not considered as the preferred method to repair thumb finger pulp defect.The great toe fibular free flap is the best in the aspects of sensory recovery,two-point discrimination and late functional assessment of hand skin flap.It is the ideal method way to repair thumb finger pulp defect.But the operation time and blood loss is the most of all tree methods.At the same time,this method is very difficult and has high surgical risk.In short,In clinical work,we should consider all aspects.such as patients’ individual demand and economic conditions,the surgeons’ clinical experience and the hospital technical level and select the reasonable surgical method in oder to treat reasonably and effectively.