Clinical effect of free flap repair of digital defect by great toe fibular flap
10.3760/cma.j.cn114453-20230526-00116
- VernacularTitle:趾腓侧游离皮瓣修复指端缺损的临床效果
- Author:
Daolian TENG
1
;
Jia LI
;
Dawei WANG
;
Guangnan PEI
;
Hui ZHU
;
Jie FANG
Author Information
1. 徐州仁慈医院手外科，徐州 221004
- Keywords:
Finger injuries;
Great toe fibular flap;
Free flap;
Finger defects
- From:
Chinese Journal of Plastic Surgery
2023;39(9):960-965
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical effect of repairing fingertip defects with the great toe fibular flap.Methods:A retrospective analysis was conducted on the clinical data of patients admitted to the Department of Hand Surgery, Xuzhou Renci Hospital from March 2019 to June 2022 who underwent the repair of fingertip defects using the great toe fibular flap. Emergency debridement of the wound of digital defect, temporary cover with xenocortic, and flap repair after 4-7 d. According to the size of digital defect, the free flap (0.5 cm larger than the wound) on the fibular side of the toe was designed and harvested, and the nail bed and phalange could be carried when accompanied by nail bed and phalangeal defects. Remove excess fat under the flap under the microscope and cover it on the wound at the end of the finger, and the flap was anastomosed with the arteries, veins, and nerves of the finger. Fix the phalanges crosswise with two 0.8 mm Kirschner needles. The wound in the donor area was directly pulled and sutured, or the suture was reduced and then moistened and changed, and it was allowed to grow on its own, or the first plantar back full thick skin sheet was transplanted and repaired. Provide an appropriate description of the surgical method, including the management of the donor recipient area. Regularly follow up the patient’s injured finger and donor foot recovery after surgery, and investigate whether the patient was satisfied with the surgical effect. At the last follow-up, finger function was evaluated using the applicable standards for upper limb functional assessment of the Chinese Medical Association Society of Hand Surgery.Results:A total of 35 patients with fingertip defect and phalangeal bone exposure were enrolled, including 17 males and 18 females. Age range from 15 to 60 years old, with an average of 36 years old. There were 9 thumbs, 8 index fingers, 10 middle fingers, 5 ring fingers, and 3 little fingers. Defect area 1.0 cm × 1.5 cm-2.0 cm × 3.0 cm. Three patients underwent venous crisis after surgery and survived after bleeding at the edge of the flap. The remaining flaps survived smoothly. There was one case of poor wound healing after removing the suture in the donor area, which healed after changing the dressing for 3 weeks. The postoperative follow-up was 10-18 months, with an average of 13 months. The color, texture, and nail appearance of the repaired finger flap were similar to those of normal fingers, with clear skin lines and beautiful appearance. The two point resolution of the flap was 8-10 mm, and the sensation returned to S3 level. No significant impact on foot function and appearance. The patient expressed satisfaction with the surgical effect. Finger function evaluation results: 28 cases were excellent and 7 cases were good.Conclusion:After using the great toe fibular flap to repair the fingertip defect, the appearance and function of the finger are restored well, and the donor area of the flap is concealed, with little impact on the donor foot, which can achieve good repair results.
