Fingertip reconstruction with V-Y advancement flap and nailbed suture following Allen’s type Ⅲ amputation: a report of 16 cases
10.3760/cma.j.cn114453-20221025-00340
- VernacularTitle:V-Y推进皮瓣并甲床直接缝合修复Allen Ⅲ型指尖离断16例
- Author:
Yiming LU
1
;
Bin WANG
;
Tianliang WANG
;
Yang WANG
;
Jiaxiang GU
;
Naichen ZHANG
Author Information
1. 江苏省苏北人民医院手足外科，扬州 225001
- Keywords:
Finger injuries;
Replantation;
Flap;
Nails
- From:
Chinese Journal of Plastic Surgery
2023;39(8):868-872
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To discuss the effect of fingertip reconstruction with V-Y advancement flap and nailbed suture treating Allen’s type Ⅲ amputations unsuitable for vascular anastomosis.Methods:From September 2018 to December 2020, clinical data of patients with Allen’s type Ⅲ fingertip amputations treated in Northern Jiangsu People’s Hospital were analyzed retrospectively. The fingertips were reconstructed with V-Y advancement flap and nailbed suture. The infeasibility of vascular anastomosis was checked under the microscope. Following fixation of the distal phalanx, the nailbed was stretched as flat as possible and sutured. If the nail plate was missing, a manual nail plate made from a plastic transfusion pipe would be fixed to cover the exposed nailbed. The palmar soft tissue of the amputated fingertip was excised, and periosteum, hyponychium, nailbed, and dorsal soft tissue were retained. The proximal volar skin was incised until the subcutaneous adipose layer to get a V-Y advancement flap. The volar defect was repaired with the V-Y advancement flap distally sutured with the pre-retained hyponychium. Postoperatively, burn cream was smeared on the nail for moisturizing, without lamp heating, and intravenous antibiotics was administered routinely. The main indexes were collected including nail appearance, pulp plumpness, static two-point discrimination, motion loss of the distal interphalangeal joint, and patients’ self-evaluation of the appearance. Chinese Medical Association trial standard of upper limb partial function assessment (CMA evaluation) was used to evaluate finger function.Results:A total of 16 patients with 18 fingertips were included. There were 9 males and 7 females, aged (31.5±6.1) years (21-52 years). There were 14 cases of single fingertips injury and 2 cases of multiple fingertips injury. Damaged finger: 2 of thumb, 3 of indicator finger, 6 of middle finger, 5 of ring finger, 2 of little finger. All 18 fingertips survived postoperatively and followed up for 7-16 months (median 12 months). One case underwent a second surgery due to infection and mild bone exposure followed by good healing. One case had a slightly hooked nail. The fingertip appearance was satisfying or acceptable by all the patients except the above two. Good results were got for all patients such as bone healing, smooth nail, plump pulp, and flexible distal interphalangeal joint. At the latest follow-up, motion loss of the distal interphalangeal joint was 0°-3.6° (mean 2.4°) for extension and 2.0°-12.0° (mean 7.6°) for flexion. The static two-point discrimination was 2.5-4.6 mm (mean 3.8 mm). Respectively, the functional evaluation of the affected finger was excellent in 11 cases, good in 3 cases and fair in 2 cases according to the CMA evaluation.Conclusion:Fingertip reconstruction with V-Y advancement flap and nailbed suture is a good technique to treat Allen’s type Ⅲ amputations, with advantages of preserved fingertip length, smooth nail, plump pulp, good sensory and flexible distal interphalangeal joint. The technique is simple with a high success rate and good results.
