Clinical efficacy of repairing dorsal defects in the distal segment of the finger with the dorsal nail flap of the great toe
Objective To analyze the clinical efficacy of repairing composite tissue defects in the dorsal end of the finger using only the dorsalis pedis nail flap supplied by the dorsalis pedis artery.Methods A retrospective analysis was conducted on 54 traumatic patients admitted to our hospital from May 2018 to December 2023,including 38 males and 16 females.All had dorsal nail beds,skin soft tissues,or combined bone defects in the distal finger segments.The age ranged from 18 to 63 years old,with an average of 34 years.28 cases in the experimental group were treated with the dorsal nail flap of the great toe,which only supplied blood to the dorsal artery of the great toe;the control group of 26 cases were treated with other non-nail flaps for wound repair.Compare the surgical time between the two groups after surgery,observe the appearance and color of the skin flap during the last follow-up,and use the upper limb functional evaluation trial standard of the Chinese Medical Association Hand Surgery Society to evaluate the sensation of the skin flap and the recovery of hand function.Results All 54 skin flaps survived,of which 5 experienced vascular crisis.which was alleviated through active vascular crisis exploration and treatment.The wound and donor site all healed in stage Ⅰ.All patients were followed up for 3-24 months,with an average of(13±5.6)months.Surgical time:the experimental group was(4.3±0.36)hours and the control group was(2.1±0.27)hours,with statistically significant differences(P<0.05).Satisfaction with the appearance and color of the skin flap:in the experimental group,there was 1 case of atrophy,2 cases of scars,and 2 cases of discoloration;in the control group,there were 2 cases of atrophy,4 cases of scars,and 2 cases of discoloration.The appearance of the other cases was good,and the differences were statistically significant(P<0.05).Skin flap sensation recovery:in the experimental group,there were 5 cases of S1 grade,1 case of S1+grade,19 cases of S2 grade,and 3 cases of S3 grade;in the control group,there were 8 cases of S1 grade,7 cases of S1+grade,8 cases of S2 grade,and 3 cases of S3 grade,and the differences were statistically significant(P<0.05).Hand function recovery:in the experimental group,there were 20 cases with excellent results,6 cases with good results,and 2 cases with moderate results,with an excellent and good rate of 92.86％;in the control group,there were 17 cases with excellent results,5 cases with good results,and 4 cases with moderate results,with an excellent and good rate of 84.62％,showing significant differences.Conclusions The dorsal great toe nail flap,which only matches the blood supply of the dorsal great toe artery,is used to repair the composite tissue defect of the dorsal end of the finger.The postoperative appearance and function of the nail flap are satisfactory without significant atrophy,and the treatment effect is satisfactory.It is worthy of clinical promotion.
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