Clinical Study On Repair Of Thumb Skin Injury With Thenar Retrograde Island Flap And Abdominal Flap

Clinically,it is very common that trauma caused by various reasons would lead to soft tissue defects of the thumb.Since the function of thumb accounts for about 40%-50%of the hands function,so thumbs are very important.The treatment of the soft tissue defect of thumb aims to preserve the length of thumb and restore its integral structure,and ensures the function of thumb as much as possible.Currently,the thumb skin defects is generally treated with surgical flap.There are many kinds of flaps could be used for this cure depending on the area of the soft tissue defect,the position of the defect,the condition of the medical institution,the technical level of the medical personnel and the expected value of patients.Clinically,abdominal flaps and thenar retrograde island flaps are the most common flaps for this cure,and the kind of flaps require relatively simple operation and have remarkable clinical effects for the treatment of soft tissue injury of thumb.The abdominal flap has the some advantages including wide application,simple operation,safety for cutting,etc.,so treatment with abdominal flaps is suitable for the primary medical institutions to carry out.With the development of clinical research,it is found that the bloated shape of abdominal flap will affect the appearance,and a second-stage surgery is required to thin flap;Moreover,the long-term forced position tend to cause anchylosis of the injured limb.In addition,the flaps also have many disadvantages such as non-wear resistance,no sensory reconstruction,so these flaps are gradually no longer the preferred treatment option.The clinical application of the thenar eminence retrograde island flap to repair the soft tissue defect of the thumb is recognized gradually and has accurate clinical effects.Objective:To explore the clinical effects and postoperative complications of thenar eminence retrograde island flap and abdominal flap for repairing soft tissue defect of thumb,aiming to provide basis for selecting the therapeutic schedule for curing soft tissue defect of thumb.Method:A total of 46 patients(n=46)with thumb injury in our hospital,from2015.8 to 2017.10 were selected,including 25 cases(54%)of heavy crush injury,13 cases(28%)of sharp-appliance injury,3 cases(7%)of hot crush injury,and 5 cases(11%)of other injuries.In the control group,30 patients(n1=30)were repaired with the abdominal flap,and 22 males(73%)and 8females(27%);the age ranged from 28 to 60 years,with an average age of42.00±9.18 years.Injury mechanism:16 cases of heavy crush injury,9 cases of sharp-appliance injury,2 cases of hot crush injury,and 3 cases of other injuries;the skin defect area was 2.0 cm×1.5 cm-2.5 cm×2 cm,with an average area of 3.56±0.48 cm~2.In the observation group,16 patients(n2=16)were repaired with the thenar retrograde island flaps.13 males(81%)and 3females(19%);the age ranged from 32 to 65 years,with an average age of45.00±8.88 years.Injury mechanism:9 cases of heavy crush injury,4 cases of sharp-appliance injury,1 case of hot crush injury,and 2 cases of other injuries;the skin defect area was 2.0 cm×1.5 cm-3 cm×2 cm,with an average area of 4.00±0.91 cm~2.The number of survived flaps in the first treatment stage,the patient satisfaction,the number of second-stage revisions,the activity of the limbs and elbow joints at 2 months postoperatively of the two groups were observed.The differences between these two groups were compared with statistical methods,and detect whether the difference is statistically significant.Results:All patients were followed up for at least 3 months.(1)In the control group,all flaps in 30 cases survived,and 20 cases(67%)were healed in the first stage,and 10 cases(33%)were partially necrotic at the edge of the flap,this partially necrotic were surgically cured and healed in the second stage.In the observation group,flaps in 16 cases(100%)survived in one stage,and 2cases(12.5%)had no-smooth venous return after operation.The suture of the flap was removed in time,and the blood was transferred with the distal acupuncture to promote blood return and then flaps healed well.The difference between 2 groups was statistically significant(2=5.00,p=0.025).(2)Guidance for postoperative patient having functional exercise.After 2 months,the outpatient clinic review was carried out,and the mobility of the shoulder and elbow joints was measured.According to the healthy side,evaluate the activities of shoulder and elbow joint in injury limb.Among 30 patients in the control group,18 patients’activity had not been affected,10 patients were obviously restricted,and 2 were mildly restricted.None of the 16 patients in the observation group had restricted shoulder and elbow joint activity.The difference was statistically significant(2=6.70,p=0.01).(3)In the control group,21(70%)had the second surgery for thinning flaps because of unsatisfactory appearance caused by the edema of flaps.Nine cases(30%)had a bloated appearance,but the patients had lower demands for the aesthetics and function and gave up the second surgery.In the observation group,16patients had beautiful skin flaps and didn’t need for thin surgery.Four patients(25%)had a feeling of discomfort in the skin grafting area.The satisfaction of patients in the control group was 33.33%,and the satisfaction of patients in the observation group was 75%.Conclusion:In the treatment of soft tissue defects of thumb,the thenar retrograde island flaps are superior to the abdominal flap,and has many advantages,including higher first-stage healing rate,beautiful appearance of the flap,without joint stiffness complication,higher patient satisfaction,which is worthy of clinical promotion.