Clinical Research Of Digital Internal Artery Dorsal Cutaneous Branch-chain Flap With Dorsal Digital Nerves In Repairing Of Fingertip

Objective To explore the effect of using proper digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves for repairing of fingertip defect.Methods From January 2013 to March 2015 (see a doctor in the people’s liberation army 371 hospital) microsurgery total of 53 cases with fingertip defect, which were repaired. Among them:digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves 13 cases (14 fingers), abdominal random flap 10 cases, free hallux toenail flap 5 cases, V-Y advancement flap12 cases, retrograde island flap with digital internal artery 13 cases.13 cases were used to digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves male 9 cases, female 4cases, Aged from 19 to 60 year-old, with an average age of 39.1 year-old, injury due to crush injury 5 cases, saws cutting 6 cases, bitten injury 2cases.8 Cases with soft tissue of pulp and part of bone defect; 5 cases of fingertip defect. The flap was devised at the middle and distal of proximal knuckle of thumb, with pedicle of artery dorsal cutaneous branch. The flap was devised at the middle and distal of middle phalanx in index finger、middle finger、ring finger or little finger,with pedicle of artery dorsal cutaneous branch. The flap size was based on wound area. The flap ranged from 2.2cm × 1.2cm to 3.8cm × 2.5cm,13 cases digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves and 13 cases retrograde island flap with digital internal artery, all cases were made neurorrhaphy connecting dorsal branch of the proper digital nerve and nerves of injured finger. After 12 days removed stitches began to functional exercise. According to the design requirements, included in the statistics of all patients were followed up,a total of 53 patients. The follow-up content included:shapes、color、texture、sweating、nociceptive sensory、 2 points discrimination (2PD)、comprehensive sense and total active motion (TAM) etc. Based on the different operation methods, time、total cost、comprehensive feeling quality、 skin feeling recovery、satisfaction、two-point discrimination and total active motion were compared.Results All of 53 cases with flaps survived postoperation,and follow-up time ranged from 1 to 1.5 years, mean time 15.8 months. According to the final checks of all cases,the group of using proper digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves、the group of using free hallux toenail flap and the group of using retrograde island flap with digital internal artery obtained satisfactory results in color、 texture and shape, the above three groups were all superior to the group of using abdominal random flap and the group of using V-Y advancement flap (P< 0.05); In terms of sensory recovery and comprehensive satisfaction, the group of using proper digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves were superior to the other groups(P<0.05); In terms of 2PD, the group of using proper digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves were superior to the group of using abdominal random flap、the group of using free hallux toenail flap and the group of using V-Y advancement flap(P< 0.05), there was no statistically difference between the group of using proper digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves and the group of using retrograde island flap with digital internal artery(P> 0.05).Conclusion The digital internal artery dorsal cutaneous branch-chain flap with dorsal digital nerves for repairing of fingertip defect postoperation, in comprehensive sense、 sensation level、comprehensive satisfaction and two-point discrimination has advantages, is an ideal operation method for repairing of fingertip defect.