The Feasibility Research Of Repairing Degloving Injuries Of The Whole Thumb By Combining The Flaps From Bilateral Big Toes

Objective: To explore the the feasibility of combined free wrap-around flap of the bigtoe and fibular flap of the contralateral big toe in treating degloving injuries of the wholethumb．Methods: The experiment of living body measurement and cadaveric model wereincluded in the research.The experiment of living body measurement:the skins of thewhole thumb in60cases were divided into dorsal part and palmar part,according to boththe radial midline and ulnar midline of the thumb. The length（H1）,the proximal width（H2）and the distal width（H3）of the dorsal part of the thumb were measured. The length（H4）,the proximal width（H5）and the distal width（H6）of the volar aspect of the thumbwere measured.Also, the length（F1）,the proximal width（F2）and the distal width（F3）of the wrap-around flap of the one big toe were measured. And the length（F4）,theproximal width（F5）and the distal width（F6）of the fibular flap of the contralateral big toewere measured．These datas were processed by SPSS16．0software，and the difference ofcorresponding diametes were compared with zero.The experiment of cadaveric model:30cadavers model of degloving injuries of the whole thumb were made.The size of skin andwound surfaces were measured. Flap coefficient was calculated.The flap was designed andcutted according to flap coefficient,and the model of degloving injury of the whole thumbwas repaired, the effect after being repaired was observed.Results：The measurements and statistical analysis showed F1（6.79±0.39）cm>H1（5.36±0.39）cm,P<0.05;F4（6.99±0.22）cm>H4（5.61±0.37）cm,P<0.05;（F2+F5）（8.31±0.66）cm>（H2+H5）（6.99±0.58）cm,P<0.05;（F3+F6）（5.59±0.37）cm>（H3+H6）（4.62±0.57）cm,P<0.05;The experiment of living body measurement pointed out that the corresponding diameter size of the wrap-around flap of the one big toe andfibular flap of the contralateral big toe was higher than that of skin of the whole thumb.Large enough flap from wrap-around flap of one big toe and fibular flap of another big toecan be respectively provided to cover the wound surface of dorsal and volar side of thewhole thumb.The flap coefficient of the length was1.1,and that of the width was1.8afterbeing measured and calculated.The appearance of thumb model was similar to normalthumb after being repaired.Conclusions: The surgical operation of combined free wrap-around flap of theipsilateral big toe and fibular flap of the contralateral big toe in treating degloving injuriesof the whole thumb is an ideal method. The original length of the big toe was reserved.Flap coefficient was a simplified new tool for the clinical treatment of degloving injury ofthumb.