A Feasibility Study Of Joining Flaps From The Bilateral Great Toes To Repair Degloving Injury Of The Distal Thumb

Objective To explore the feasibility of joining the dorsal wrap-around flap of the ipsilateral great toe and the fibular flap of the contralateral great toe to repair the degloving injury of the distal thumb.Methods This study includes establishment of a model and simulation of the repair. The establishment of model:twelve left thumbs of cadaver specimens were used as models of degloving injuries of the distal thumbs. We measured the length of the dorsal degloving skin and the dorsal wound, the width of the proximal dorsal degloving skin and the proximal dorsal wound, the width of the distal dorsal degloving skin and the distal dorsal wound, the length of the Palmaris degloving skin and the Palmaris wound, the width of the proximal Palmaris degloving skin, the width of the proximal Palmaris wound, the width of the distal Palmaris degloving skin, the width of the distal Palmaris wound. Then a coefficient of the flap was calculated. The simulation of repair:designing and cutting out the dorsal wrap-around flap of the ipsilateral great toe and the Fibular flap of the contralateral great toe according to the coefficient of the flap, Joining flaps from the bilateral great toes to repair model of the thumb, observing the repair efficiency.Results Dorsal skin of the thumb model:the length (3.17±0.17) cm; the width of the proximal (4.52±0.42) cm、the width of the distal (2.87±0.28) cm。Palmaris skin of model of the thumb:the length (3.17±0.17) cm、the width of the proximal (1.87±0.18) cm、 the width of the distal (1.36±0.13) cm。Dorsal wound:the length (2.75±0.20) cm、the width of the proximal (3.21±0.30) cm、the width of the distal (1.47±0.16) cm。Palmaris wound:the length (2.92±0.27) cm、the width of the proximal (1.24±0.11) cm、the width of the distal(0.86±0.12)cm。Calculating coefficient of the flap:Length coefficient1.2, width coefficientl.6. The appearance of the repaired model of the thumbs is similar to one of the contralateral normal thumb.Conclusion Joining the dorsal wrap-around flap of the ipsilateral great toe and fibular flap of the contralateral great toe is a good method in repairing degloving injury of the distal thumb. The repaired thumbs look like the native with minimal damage. Flap coefficient is a new simplified tool for the design of repairing degloving injury of thumb.