Objective:To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods:In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital, 6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March, 2015 to December, 2019. There were 5 males and 1 female with an average age of 35.8 years (range, 16-55 years). Among them, there were 2 cases with crush injury, 1 case with wringer injury, 1 case of with thermal crush injury, 1 case with power saw injury and 1 case of traffic accident injury. Of which, 3 cases of middle phalanx defect and 3 cases of proximal phalanx defect. 1 case of thumb and ring finger, respectively, 2 cases of index and middle finger. 2 cases of left hand and 4 cases of right hand/side. There were 6 cases with tendon defect and 3 cases with other finger injury. Soft tissue defect area: 5.5 cm × 2.0 cm to 6.0 cm × 3.0 cm. The length of phalangeal defect: 1.5 cm to 2.2 cm. The area of flap: 6.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. The size of bone-flap: 1.8 cm × 1.0 cm × 0.8 cm to 2.2 cm × 1.0 cm × 1.0 cm. The donor site was either directly sutured or covered by transposing local flap. Follow-up plan was setafter operation. All patients were followed-up by outpatient service telephone, wechat and home visit etc. The dimensions of follow-up included the appearance, function, living and working conditions regarding the injured finger after operation. The evaluation was carried out according to the evaluation criteria of the society of hand surgery, Chinese Medical Association and the Michigan hand function evaluation criteria.Results:All the flaps survived. The flaps were followed-up for 9 to 24 months, with a small amount of pigmentation, good texture, moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm. There was no functional effect on the lower leg. The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were as follows: excellent 3 fingers, good 3 finger, excellent rate was 100%. According to Michigan Hand Function Evaluation Criteria, 6 fingers scored from 71.5 to 91.8 points, with an average of 80.6 points.Conclusions:Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent, with little damage to the donor site. It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.

Objective:To investigate the clinical effect on bridging replantation of defective severed fingers with the anterior tibial artery perforator bone-skin flap.Methods:In the Department of Hand and Foot Microsurgery of Dongguan Chang’an Xin’an Hospital, 6 cases of finger defect were repaired and replanted utilizing proximal tibial artery perforator bone-skin flap from March, 2015 to December, 2019. There were 5 males and 1 female with an average age of 35.8 years (range, 16-55 years). Among them, there were 2 cases with crush injury, 1 case with wringer injury, 1 case of with thermal crush injury, 1 case with power saw injury and 1 case of traffic accident injury. Of which, 3 cases of middle phalanx defect and 3 cases of proximal phalanx defect. 1 case of thumb and ring finger, respectively, 2 cases of index and middle finger. 2 cases of left hand and 4 cases of right hand/side. There were 6 cases with tendon defect and 3 cases with other finger injury. Soft tissue defect area: 5.5 cm × 2.0 cm to 6.0 cm × 3.0 cm. The length of phalangeal defect: 1.5 cm to 2.2 cm. The area of flap: 6.5 cm × 2.0 cm to 7.0 cm × 3.0 cm. The size of bone-flap: 1.8 cm × 1.0 cm × 0.8 cm to 2.2 cm × 1.0 cm × 1.0 cm. The donor site was either directly sutured or covered by transposing local flap. Follow-up plan was setafter operation. All patients were followed-up by outpatient service telephone, wechat and home visit etc. The dimensions of follow-up included the appearance, function, living and working conditions regarding the injured finger after operation. The evaluation was carried out according to the evaluation criteria of the society of hand surgery, Chinese Medical Association and the Michigan hand function evaluation criteria.Results:All the flaps survived. The flaps were followed-up for 9 to 24 months, with a small amount of pigmentation, good texture, moderate thickness and the two-point discrimination of the flaps ranged from 8 to 11 mm. There was no functional effect on the lower leg. The healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association, the results were as follows: excellent 3 fingers, good 3 finger, excellent rate was 100%. According to Michigan Hand Function Evaluation Criteria, 6 fingers scored from 71.5 to 91.8 points, with an average of 80.6 points.Conclusions:Using the anterior tibial artery perforator bone-skin flap to bridge the defect and replantation can restore the appearance and function of the fingers to a large extent, with little damage to the donor site. It is an effective surgical method to repair bone-skin defects and restore the length in the replantation of defective severed fingers.

Objective:To investigate the clinical effect of free anterior tibial artery proximal periosteal perforator bone-skin flap for repairing phased thumb defect.Methods:Eight patients of phased defect of thumb were repaired from March, 2013 to January, 2019 utilizing proximal tibial artery periosteal perforator bone and skin flap. Of which, 2 cases suffered defects at interphalangeal joint of thumb, 3 in proximal phalanx, and 3 at thenar muscle and metacarpale. There were 4 cases with tendon defect, 6 cases with other finger injuries.The areas of soft tissue defect was 4.5 cm×2.5 cm to 7.2 cm×4.0 cm, and the length of metacarpale bone defect was 1.2 to 2.5 cm. The flap size ranged from 5.0 cm×3.0 cm to 7.5 cm×4.5 cm, and the bone flap size was 1.2 cm×1.0 cm×0.8 cm to 2.5 cm×1.0 cm×1.0 cm. Six cases received direct suture or local skin metastasis in anterior tibial region and 2 cases with skin grafting. All patients were followed-up by clinic visits, telephone or WeChat reviews, and home visits.Results:All the flaps survived after surgery. A 6 to 24 months followed-up showed that the flaps were normal in colour with good texture and moderate thickness. TPD of the flaps ranged from 7 to 10 mm. The donor site of the shank had good appearance and were in normal function, and the walking were not affected. Healing time of transplanted bone flaps ranged from 2.0 to 4.0 months, with an average of 2.6 months. According to the Evaluation Criteria of Upper Limb Function of the Hand Surgery Society of Chinese Medical Association, the results were excellent in 7 thumbs and good in 1 thumb. According to Michigan Hand Function Evaluation Criteria, 8 thumbs scored 81.3 to 91.8 points, with an average of 83.6 points.Conclusion:The reconstruction of phased defect of thumb with proximal tibial artery periosteal perforator bone-skin flap can restore the appearance and function of thumb to the greatest extent, and the affect to donor site is minimum. It is an effective surgical method for repairing phased defect of thumb.

Objective: To report the clinical effect of skin grafting in small wounds with exposed vascular anastomosis. Methods: From January, 2011 to May, 2018, 16 small wounds with anastomotic vascular exposure were treated by full-thickness skin grafting. Of which, 4 performed after replantation, 9 after reconstruction and 3 after flap transplantation. Thirteen wounds were on hand and 3 in foot. After anastomosing the vessels, 3 arterial anastomoses, 9 venous anastomoses and 4 arterial-and-venous anastomoses were left exposure in wounds. Sizes of artery exposed in wound were 0.8 to 2.3 mm with an average of 1.0 mm. Sizes of vein exposed in wound were 0.8 to 2.5 mm with an average of 1.2 mm. The areas of soft tissue defect were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm, and the areas of grafted skins were 1.0 cm×1.5 cm to 2.6 cm×6.0 cm. Grafted skin were covered without package nor pressurization. Donor areas were directly sutured. Postoperative follow-up was conducted to observe the postoperative effect. Results: Fourteen grafted skin completely survived, one partially survived and healed after immobilization of the limb and change of dressing, and one developed necrosis. All patients were followed-up for 6-24 months (mean 14.4 months). CDU, HHD or CTA were used at the final follow-up. Vascular anastomoses were patency in 15 patients, and 1 patient had embolism developed. No pigmentation was found on the grafted skin. All grafted skin was soft and wearable with two point discrimination at 7-10 mm. The pulse of anastomotic artery could be felt on the grafted skins. Only linear scars were left in the donor sites. Conclusion The operation of full-thickness skin grafting in small wounds with exposed vascular anastomosis was easy to perform and with high survival rate. The effect of operation is satisfactory. The exposure of anastomosed vessels does not affect the patency of anastomotic vessels, and has considerable clinical values.