The Research Of Repairing Class â…¡ Degloving Injuries Of Fingers By Combining The Flaps Of The Second Toes

Objective:To introduce a new surgical procedure for repair of class II degloving injuries of fingers.Methods:Basic research included experiments of living body measurement and autopsy experiment. In the living body measurement,50healthy adults (female,25and male,25) without hand diseases were randomly selected. Skin of the whole middle finger was divided into dorsal part and palmar part, according to both sides of midlateral line. The length, the proximal width and the distal width of both parts were measured. The length, the proximal width and the distal width of second toe dorsal nail-skin flap with dorsalis pedis flap and second toe medial flap with dorsalis pedis flap were measured, and compared with each other. The autopsy experiment included model establishment and simulation operation. The middle fingers were made to the models of degloving injury of the whole finger in twenty flesh cadaveric specimens. The wound and the degloved skin were divided into two parts:the dorsal part and the volar part. The length, the proximal and distal width of the wound and degloved skin were measured. Flap coefficients were calculated from the above data according to flap coefficient=length of skin/length of wound. The second toe dorsal nail-skin flap with dorsalis pedis flap and second toe medial flap with dorsalis pedis flap were designed and harvested according to flap coefficient, and used to repair model of class II degloving injury of finger. The repairing effects were observedResults:The length of the dorsal part of the combined flap was12.32±0.43cm, the volar part was11.18±0.36cm, the proximal circumference was8.39±0.44cm, and the distal circumference was4.79±0.34cm. The length of the dorsal part of the middle finger was8.71±0.41cm, the length of the volar part was7.82±0.38cm, the proximal circumference was6.56±0.35cm, and the distal circumference was3.93±0.32cm. As a result, the second toe flaps from both the feet were large enough to repair the degloving injury of the whole finger. There was a constant proportional relationship between skin and wound, which was named flap coefficient. The length coefficient was1.2, and the width was1.6. The second toe dorsal nail-skin flap with dorsalis pedis flap and second toe medial flap with dorsalis pedis flap harvested according to flap coefficient were used to repair the degloved finger and achieved satisfactory appearance. The appearance of the repaired finger was similar to normal finger. Conclusions:This method of second toe dorsal nail-skin flap with dorsalis pedis flap combined with second toe medial flap with dorsalis pedis flap for the reconstruction of the degloved fingers was feasible. The appearance of reconstructed finger was good and It needed not to sacrifice the toe. The flap coefficient was beneficial for us to simply and accurately design skin flaps for repairing degloving finger injuries.