Thumb defect reconstruction with a large dorsal radius neurocutaneous vascular flap of thumb
Objective To explore the surgical method and clinical effect of wrapping the exposed phalanx with a large dorsal radius neurocutaneous vascular flap of the thumb to reconstruct the distal segment of the thumb.Methods From Apr.2019 to Aug.2022,7 patients with amputated distal segment of the thumb that cannot be re-planted or failed in replantation due to severe tissue damage were hospitalized in the NO.987 Hospital of the PLA Joint Logistics Support Force.There were 6 males and 1 female aged 20-51 years,mean 39.4 years.There were 5 cases of squeezing injury and 2 cases of cutting injury with 4 on the left and 3 on the right.Four cases were unable to be replanted due to severe finger damage,and 3 cases underwent skin flap repair after failed replantation.After removing necrotic soft tissue on the proximal severed finger,the phalanx was preserved,and a large dorsal radius neurocutaneous vascular flap of the thumb was used to wrap the exposed phalanx to reconstruct the distal phalanx.The donor site was then covered by grafts.The appearance and sensation of the flap,donor site condition,and hand functional recovery were followed up after discharge.Results The size of the defect area was 2.5 cm×4.5 cm to 3.0 cm × 6.0 cm,while the flap was slightly larger,with the size being 2.5 cm × 5.0 cm to 3.5 cm × 6.5 cm.All the 7 large flaps and the donor site grafts survived.Patients were followed up for 3-20 months,mean 4.6 months.After 3 months of surgery,the skin flap showed a plump appearance,no bloating,and a satisfactory texture.The sen-sation was initially established.According to the tentative criteria for upper limb function evaluation by the Society of Hand Surgery,Chinese Medical Association,the finger function was evaluated as excellent in 5 cases,good in 1,and fair in 1,with an excellent-to-good rate of 85.7％.Conclusion Reconstruction of the distal segment of the thumb by wrapping the exposed phalanx with a large dorsal radius neurocutaneous vascular flap of the thumb is a simple and successful surgical procedure with minimal invasion to the donor site and satisfactory clinical outcomes.It is worthy of promotion in grassroots hospitals.
万方数据
维普
