Clinical Application Study Of Venous Flow Through Flaps For Repair Of Digital Wound With Artery Defect

Objective To explore the methods and clinical effects of venous flow through flaps for repair of digital wound with artery defect.Methods From February 2004 to September 2017,forty-nine patients with digital wounds of 53 fingers with the defect of proper palmar digital artery treated by venous flap from the forearm with bridging were analyzed retrospectively.There were 37 males and 12 females.The patients were 18 to 55 years old with the average age of 32 years.The causes of injury were crush injury in 22 cases,cutting injury in 14 cases,twist injury in 6 cases,chainsaw injury in 5 cases,and accident injury in 2 cases.There were 24 fingers in 22 cases in the right hand and 29 fingers in 27 cases in the left hand.Injured fingers included 2 thumbs,22 index fingers,20 middle fingers,6 ring fingers,and 3 small fingers.There were 53 injured fingers in 49 cases with skin soft tissue defect and proper palmar digital artery defect.The area of skin soft tissue defect was from 1.3cm×0.8cm to 6.0cm×2.5cm and the length of artery defect was from 1.0 to 6.5cm with the average length of 2.6cm.In 53 fingers,one proper palmar digital artery was bridged in 46 fingers and bilateral arteries were in 7 fingers.18 amputated fingers were treated by bridging.Among the 18 fingers,bilateral arteries were bridged in 4 fingers and one proper palmar digital artery was bridged in 14 fingers.Subcutaneous veins were bridged in all the 18 fingers.The flap was inverted and used to repair the recipient site in 26 fingers and the flap was to repair the recipient site in 27 fingers uprightly.According to the severity of digital injury and condition of peripheral circulation,the wounds needed to be repaired by venous flow through flap were divided into three groups:Type Ⅰ,the wound with one proper palmar digital artery injured and no significant impediment of digital blood supply;Type Ⅱ,the wound with bilateral proper palmar digital artery injured and insufficient of digital blood supply;Type Ⅲ,amputated fingers with the wound and artery defect.According to the wound type,the venous flaps were designed into three types for repair of the above three wounds.For TypeⅠ,an input venous flap with single stem with bridge of one proper palmar digital artery was selected;For Type Ⅱ,an input venous flap with two stems with bridge of bilateral proper palmar digital artery was selected;For Type Ⅲ:an input and output venous flap with two or more stems with bridge of the artery and vein were selected.Results There were 53 fingers in 49 cases.Arterial crisis occurred in 4 fingers after operation.The arterial crisis was relieved by conservative treatment in 2 fingers,and by vessel anastomosis after exploration of thromboembolism at the anastomotic stoma of proximal digital artery.Tension blister occurred in 11 fingers within 3 days after surgery.The symptomatic was relieved by treatment of immediate puncture,pumping and dressing change in 7 fingers.The blisters recurred with severe swelling in 4 fingers,resulting into venous crisis.After surgical exploration,the hematoma compression occurred in one case.For this case,the symptomatic was relieved after the hematoma was cleared and bleeding was stopped.Thromboembolism at the anastomotic stoma occurred in one case and the symptomatic was relieved by venous bridge.Partial necrosis of flap occurred in 2 fingers and their wounds healed after dressing change.All other fingers and flaps survived and the wounds healed in one stage.All the patients were followed up.The follow-up time was from 12 to 24 months with the average time of 14 months.Mild pigmentation occurred in 5 flap,mild pigment deficiency occurred in four fingers and the color of the other flaps was to the surrounding normal skin.The texture of the flap was soft.No atrophy or swollen occurred.Linear scar occurred in the forearm flap donor site without hyperplasia or atrophy.The flexion and extension of wrist and elbow joints were good.The total joint motion was used to evaluate the motor function of the injured fingers.The excellent was in 33 fingers,the good was in 12 fingers and the fair was in 8 fingers.The excellent and good rate was 85%.The self-made evaluation form of venous flap function was used to evaluate the flaps in this group.The excellent was in 12 fingers,the good was in 34 fingers and the fair was in 7 fingers.The excellent and good rate was 87%.Conclusion According to the severity of digital injury and condition of peripheral circulation,the wounds with digital artery defect were divided into three groups and treated by three different kinds of venous flow through flaps,resulting into a precise repair.The digital wounds were covered with bridge of digital artery defects.The wounds were repaired with reconstruction of blood flow.Satisfactory results were obtained.