| Objective:To explore the clinical efficacy of the modified second toe tibial free flap for the repair of finger wounds and the recovery of donor function.METHODS:Two adult cadaver foot specimens were used,and a total of four sites were dissected under the naked eye and operating microscope to observe the probability of the medial nerve of the dorsal toe of the second toe.The position,diameter,the direction of travel and the number of branches were observed.We designed and cut the second toe temporal flap with the dorsal nerve from the cadaver specimen.In clinical application,we have observed a total of 12 cases of finger wounds repaired by the free flaps of the second toe with the dorsal nerve.In these cases,the defect area was 2.0 cm × 1.5 cm,the smallest was 1.5 cm × 1.0 cm,and the area of the flap was cut from 2.2 cm × 1.7 cm to 1.6 cm × 1.1 cm.The skin flap donor area is covered with a full thickness of the skin.12 patients were followed up for not less than 1 year follow-up.Assessment of sensory function and motor function using static the two points distance(2-PD)and the total active movement(TAM)method in the flap and donor toe.RESULTS:Clinical anatomical data showed that the medial branch of the deep peroneal nerve penetrated the deep fascia along the lateral aspect of the dorsal artery of the foot to the space of the first metatarsal.Then the nerve is divided into two branches,the dorsal lateral nerve and the medial nerve of the second toe.The medial nerve of the dorsal toe continued to descend along the medial aspect of the medial aspect of the dorsal end,and the nerves were distributed on the corresponding skin.The intrinsic nerve of the second toe is from the first toe total nerve.This nerve is accompanied by the artery of the same name along the inner side of the second toe to the toe,distributing the skin of the corresponding area.The skin of the second toe is co-administered by the toe-bottom nerve and the toe-back nerve.Simulated surgery showed that the flap can be designed to include the medial nerve of the dorsal toe of the second toe.When the flap is cut,the flap-type artery can be cut without damage and the intrinsic nerve of the second toe-side toe is retained in situ.In clinical application,we have observed a total of 12 cases of finger wounds repaired by the free flaps of the second toe with the dorsal nerve.All transplanted flaps and skin grafts were survived.The patients were followed up for 12 to 37 months,with an average of 19 months.The two points distance(2-PD)of the flap was 5?8 mm,with an average of 6.0 mm.The hand function was evaluated according to the total active movement(TAM)method:excellent 9 fingers,good 2 fingers,and 1 finger,the excellent and good rate was 91.67%.The donor area of the flap was well healed,the second toe was full,and the 2-PD of the toe was 6-1 Omm,with an average of 7.8mm.The donor area has no effect on walking and joint activities.Conclusion:The modified second toe tibial free flap can repair the finger wound.This surgical method can restore the appearance of the finger and rebuild the good sensory function,and also reduce the damage of the toe donor area.Therefore,this surgical method can obtain a satisfactory clinical effect. |
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