The Observation Of The Clinical Outcomes Of The Reverse Dorsal Digital Island Flap Sutured And Not Sutured With Cutaneous Branches Of Proper Digital Nerve In Repairing Soft Tissue Defect Of The Fingertip

Objective:To observe the clinical outcomes of the reverse dorsal digital island flap sutured and not sutured with cutaneous branches of proper digital nerve in repairing soft tissue defect of the fingertip.The difference of the sensory recovery and the range of motion of fingers was analyzed which provided a more suitable method for clinical repairing soft tissue defect of the fingertip.Methods:We selected patients of fingertip soft tissue defect from 2007 to 2018,a total of 45 cases with 45 fingers were included.20 fingers were treated using reverse dorsal digital island flap sutured with cutaneous branches of proper digital nerve.There were 14 males and 6 f’emales,aged 16-60.Of whom,12 patients were caused by machine punching injury,3 by machine twist,and 5 by cutting injury.The area of the flap ranged from 1.5cm×1.8cm to 2.2cm×2.7cm.25 fingers were treated using the reverse digital artery island flap not sutured with cutaneous branches of proper digital nerve.There were 16 males and 9 females,aged 18-53.Of whom,14 patients were caused by machine punching injury,8 by machine twist,and 3 by cutting injury.The area of flap ranged from 1.6cm×1.5cm to 3.2cm×2.2cm.If the flap survived in both groups after operation,the presence and absence complications and other conditions were observed and compared.The sensory recovery of fingers was assessed by the British Medical Research Council(1954),and the function was assessed by Hand Surgery Society of the Chinese Medical Association(appendix for details).Results:All 45 flaps survived.All the recipient wounds achieved primary healing.After 1 year follow-up,the flaps in both groups were full in shape,soft in texture,and the donor site survived without obvious pigmentation,and there was no obvious pain and movement disorder in adjacent joints.In the first group(20 cases),the results were excellent in 16 cases,good in 4 cases;achieved recovery in sensation from S3+～S4.In the second group(25 cases),the results were excellent in 9 cases,good in 6 cases;achieved recovery in sensation from S3～S3+.In the first group,20 patients were followed up for 12 to 19 months and achieved good recovery in sensation and static two-point discrimination ranged from 4.8 to 8.0 mm.In the second group,after 15 to 120 months of follow-up,25 patients also got recovery in superficial sensation,only 20 patients got 6.8 to 15.0mm in static two-point discrimination,5 patients did not get the static two-point discrimination.One patient was followed up for 120 months,and no two-point discrimination was detectedConclusion:In the recovery of sensation and two-point discrimination,the reverse dorsal digital island flap sutured with cutaneous branches of proper digital nerve had a better effect than the reverse digital artery island flap not sutured with the nerve,it was considered as an excellent and more suitable method for clinical repairing soft tissue defect of the fingertip.But both of them achieved good results in the recovery of range of motion.