| Objective: To explore the surgical techniques and clinical results of the wrap-around flap supplied by the first dorsal digital artery and plantar digital artery for coverage defects of the fingertip.Methods:From December 2014 to May 2016,the cases are classified as the DDA group and PDA group.In the DDA group,the wrap-around flap supplied by the first dorsal digital artery was harvested to reconstruct fingertip,including 9 cases in thumb,13 cases in the index finger,8 cases in the middle finger and 6 cases in ring finger.The size of the defects ranged from 6mm×10mm to 14 mm × 28 mm.In the PDA group,the wrap-around flap supplied by the plantar digital artery was harvested to reconstruct fingertip,including 15 cases in thumb,14 cases in the index finger and 7 cases in the middle finger.The size of the defects ranged from 10mm×18mm to 25mm×40mm.The donor sites were all covered with full-thickness skin grafts.The duration of follow-ups ranged from 8 to 42 months.Results:1.Postoperative Complications:In the DDA group,there were 3 cases suffering crisis of blood-circulation in the recipient site and 6 cases with delayed union in the donor sites,and the complication rate was respectively 8.33% and 16.67%.In the PDA group,there were 2 cases suffering crisis of blood-circulation in the recipient site and 19 cases with delayed union in the donor sites,and the complication rate was respectively 5.67% and 41.67%.2.The recovery of recipient site: In the DDA group,all patients resulted in nearly-normal finger.Activities of the distal finger joint were good and fine actions completed well.There was no case accepting the secondary plastic surgery.The evaluations resulted in 31 cases in Excellent catalog,5 cases in Good catalog.In the PDA group,there were 8 cases with pulps of corpulence and fine actions of slight limitation.There were 5 cases accepting the secondary plastic surgery.The evaluations resulted in 12 cases in Excellent catalog,8 cases in Good catalog,10 cases in Poor catalog.3.The evaluation of nail growth: In the DDA group,all patients had normal nail with wellgrowth,smooth and full shape.The excellent ratio was 100%.In the PDA group,17 patients had normal nail with well-growth,but there were 7 cases with split nails,5 cases with nail hook and 3 cases with pain symptoms.The excellent ratio was 72.22%.4.The patients' satisfaction of hand reconstruction: In the DDA group,33 patients were very satisfied and 3 cases were less satisfied.The score ranged from 92 to 99,in average(96.52.5).In the PDA group,27 patients were very satisfied,5 cases were not satisfied.The score ranged from 73 to 90,in average(84.5 6.5).±±5.The recovery of the donor area: In the DDA group,all the skin grafts in the donor site survived without necrosis.There were 4 cases were slightly depressed in the donor site.The evaluations resulted in 30 cases in Excellent catalog,6 cases in Good catalog and the excellent ratio was 100%.In the PDA group,there were 6 cases were moderatly depressed in the donor site.All of them recovered well except 6 cases with weak cold resistance and abrasion resistance,3 cases with scar hyperplasia,3 cases with slightly limitation to wear shoes and weight bearing.The evaluations resulted in 16 cases in Excellent catalog,11 cases in Good catalog,9 cases in Poor catalog and the excellent ratio was 75%.Conclusions: Wraparound flaps supplied by the first dorsal digital artery and plantar digital artery both are excellent operations for function and appearance reconstruction in patients with fingertip defects.But the former can lead to a more satifified outcome with better appearance and function,fewer complications. |
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