| ObjectivesTo explore the clinical outcomes of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip.MethodsFrom March 2014 and June 2016,25 patients(30 fingers)of fingertip soft tissue defects were treated using reverse dorsal digital island flap with cutaneous branches of proper digital nerve,the clinical data were retrospectively reviewed of Department of Hand and Foot Microsurgery in Clinical Medical College of Yangzhou University.There were 19 males and 6 females,aged 16-63(averaging 39.8).Of whom,12 patients caused by machine punching injury,7 by machine twist,and 6 by cutting injury.The mean interval from injury to admission was 42.9 hours(range,0.5 hour to 6 weeks).Of then,the index finger was involved in nine cases,the middle finger in ten cases,ring finger in seven cases,and little finger in four cases,three patients had fingertip injuries of two adjacent digits,and one patient had fingertip injuries of three adjacent digits.The involved finger wound was accompanied by phalangeal fracture,exposure or partial bone defect in 11 cases,and tendon exposure in 14 cases.The proper digital cutaneous branches of the flap were sutured with the digital nerve of the wound under a microscope.The area of defect ranged from 1.3 cm×1.5 cm to 1.7 cm×3.0 cm,The flap area ranged from 1.4 cmx 1.6 cm to 2.0 cm×3.5 cm(average,2.1 cm×2.5 cm).The donor sites were sutured with autologous full-thickness skin of the medial forearm.The donor sites of full-thickness skin(second donor area)were sutured directly.ResultsAll the flaps survived,All the donor and recipient wounds achieved primary healing.Venous crisis occurred in one case which healed after the removal of some sutures.Postoperative follow-up period ranged from 6 to 18 months.The shape of the flaps was plump and the texture was soft.Partial superficial sensation of the flaps recovered without donor site pain and interphalangeal joint dysfunction.Moreover,The two-point discrimination ranged from 5 to 8 mm,with the average being 5.7±1.4 mm at 6 months after operation.At 1 year postoperatively,The average score on the Cold Intolerance Severity Score questionnaire was 20.1 ±6.7 points(range,4 to 46 points),only two patients had a moderate degree of cold intolerance.At 18 months postoperatively,the average total active motion of the metacarpophalangeal joint was 77.3±6.7 degrees(range,60 to 90 degrees),the average total active motion of the proximal interphalangeal joint was 106.2±4.1 degrees(range,95 to 115 degrees)and that of the distal interphalangeal joint was 68.8±4.0 degrees(range,55 to 75 degrees).According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association,the results were excellent 17 cases,good in 8 cases.ConclusionThe application of reverse dorsal digital island flap with cutaneous branches of proper digital nerve can achieve good sensory recovery,a single-stage procedure and without sacrifcing the proper digital nerve and dorsal branch of the nerve,with little damage in donor site,is a reliable alternative method for repairing soft tissue defects of the same fingertip. |
