Repair Of The Complex Tissue Defect Of Thumb And Fingers By First Dorsal Metatarsal Artery Flow-through Flap

Objective: To investigate the treatment of outcomes of repairing soft tissue defects of thumbs and fingers using the first dorsal metatarsal artery flow-through flap.Methods:From January 2014 to June 2016,7 patients(4 males and 3 females,patients?age ranged from 18 to 45 years,with an average of 28.5 years)with complex soft tissue defects were treated by first dorsal metatarsal artery flow-through flap.The causes of injury were: 3 cases of punch press injury,2 cases of machine cutting injury and 2 cases of crush injury.The injury index of proximal volar in 3 cases,1 cases of proximal dorsal thumb,middle finger in the palm side in 2 cases,1 cases of proximal thumb volar,including bilateral finger artery nerve defect in 2 cases,unilateral finger artery nerve defect in 4 cases,defect length from 1.8 to 3.0cm,1 cases of extensor tendon defect,defect length was 2.0cm,were unable to repair.The operation time of the injured distance was from 1.5 to 3 hours,with an average of 2 hours,and the operation time was from 3 to 4.5 hours,with an average of 3.6 hours.Application of color Doppler ultrasound in the detection of vascular type before operation,the flap area was form 2.0cm×2.5cm to 3.5cm×5.5cm,all the donor site of the flap were sutured directly.Results:All flaps survived.These cases were follow-up for 6 to 18 months,average 9 months.All the flaps got satisfactory appearance and good sense function,2-PD of the flap averaged 10 mm,ranging from 8 to 12 mm.All injured fingers got satisfactory appearance and good sense function,2-PD of the injured fingers averaged 10 mm,ranging from 6 to 15 mm.The donor site incision healed well,no obvious scar hyperplasia,good function.Conclusions: Application of the first dorsal metatarsal artery flow-through flap to reconstruct complex soft tissue defects(including arteries,nerves and tendons)of thumbs and fingers,can achieve good clinical effects,this method can restore the blood supply of the skin flap and the thumb and finger,the function and feeling of the injured fingers.It is an ideal surgical method for repairing the composite tissue defect of the thumbs and fingers.