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Title: [Effect of venous anastomosis of the pedicled digital artery dorsal branch island flap in repairing fingertip or pulp defects of the same finger].
Author: Wang H, Yang XX, Wang B, Huo YX, Chang H, Yang SH, Li JR.
Journal: Zhonghua Shao Shang Za Zhi; 2020 Nov 20; 36(11):1065-1069. PubMed ID: 33238690.
Abstract:
Objective: To explore the effect of venous anastomosis of the pedicled digital artery dorsal branch island flap in repairing fingertip or pulp defects of the same finger. Methods: From February 2016 to September 2018, a total of 56 emergency cases (67 fingers) with fingertip or pulp defects in 2-5 fingers were admitted to the Second Hospital of Tangshan (hereinafter referred to as the author's affiliation), and the prospective research was conducted. The patients were divided into venous anastomosis group of 29 cases (35 fingers) and non-venous anastomosis group of 27 cases (32 fingers) by drawing lots. There were 18 males and 11 females in venous anastomosis group, aged 17 to 62 years, with wound area of 1.6 cm×1.3 cm-3.1 cm×2.4 cm after debridement. There were 17 males and 10 females in non-venous anastomosis group, aged 20 to 59 years, with wound area of 1.7 cm×1.2 cm-3.0 cm×2.4 cm after debridement. According to the location and size of the fingertip or pulp defect of patients in the two groups, the flap was designed on the dorsum of the middle or proximal phalanx of the injured finger. During the operation, the epineurium of dorsal branch of the proper digital nerve or the dorsal digital nerve carried by the flap was anastomosed end-to-end with the stump of proper digital nerve in the wound. One or two superficial vein (s) carried by the flap was/were interrupted end-to-end anastomosed with the superficial veins on the dorsum or palm of the wound surface in venous anastomosis group, and the venous anastomosis was not performed in non-venous anastomosis group. The flap size resected ranged from 1.8 cm×1.5 cm to 3.4 cm×2.6 cm in venous anastomosis group, and that ranged from 1.9 cm×1.4 cm to 3.3 cm×2.6 cm in non-venous anastomosis group. The donor site wounds in the two groups were resurfaced by free full-thickness skin graft harvested from the proximal forearm or the medial side of the upper arm. The blood circulation of the flap of patients in 2 groups was observed after operation. During follow-up after operation, the patients' satisfaction for the appearance of the flap was evaluated by Michigan Hand Function Questionnaire, the flap color was observed by the chief physician of the Department of Hand Surgery in the author's affiliation, and the incidence of flap pigmentation was calculated. Data were statistically analyzed with t test and chi-square test. Results: All the flaps of patients survived without tension blister in venous anastomosis group after operation. Tension blisters occurred in 6 cases (6 fingers) in non-venous anastomosis group due to venous reflux obstruction, and the flaps survived after removing some sutures of the pedicle and changing dressing. During follow-up of 8-20 months, with an average of 15 months, the patients' satisfaction score for flap appearance in venous anastomosis group was (4.6±0.5) points, which was obviously higher than (4.3±0.6) points of non-venous anastomosis group (t=2.482, P<0.05). The incidence of flap pigmentation in venous anastomosis group was 9% (3/35), which was significantly lower than 31% (10/32) of non-venous anastomosis group (χ(2)=5.498, P<0.05). Conclusions: The pedicled digital artery dorsal branch island flap with venous anastomosis repairs the same fingertip or pulp defects, resulting in unobstructed venous reflux, low incidence of flap pigmentation, good appearance and high patient satisfaction. 目的： 探讨吻合静脉的带蒂指动脉背侧支岛状皮瓣修复同指指端或指腹缺损的效果。 方法： 2016年2月—2018年9月，唐山市第二医院(下称笔者单位)收治56例(67指)第2～5指指端或者指腹缺损急诊入院患者，进行前瞻性研究。采用抽签法分为吻合静脉组29例(35指)，其中男18例、女11例，年龄17～62岁，清创后创面面积1.6 cm×1.3 cm～3.1 cm×2.4 cm；不吻合静脉组27例(32指)，其中男17例、女10例，年龄20～59岁，清创后创面面积为1.7 cm×1.2 cm～3.0 cm×2.4 cm。根据2组患者指端或指腹缺损位置及大小，于受伤手指中节或近节背侧设计皮瓣，术中将皮瓣携带的指固有神经背侧支或指背神经近端与创面内指固有神经残端行端端外膜吻合。吻合静脉组患者将皮瓣携带的1条或2条浅表静脉与创面近端背侧或掌侧浅表静脉行端端间断吻合，不吻合静脉组不进行静脉吻合。吻合静脉组患者皮瓣切取面积为1.8 cm×1.5 cm～3.4 cm×2.6 cm，不吻合静脉组患者皮瓣切取面积为1.9 cm×1.4 cm～3.3 cm×2.6 cm。2组患者供区创面取前臂近端或上臂内侧全厚游离皮片覆盖。术后观察2组患者皮瓣血运情况。术后随访采用Michigan手部功能问卷评定2组患者对皮瓣外观的满意度；由笔者单位手外科主任医师肉眼观察皮瓣颜色，并计算皮瓣色素沉着发生率。对数据行t检验、χ(2)检验。 结果： 术后吻合静脉组患者皮瓣全部成活，无一例出现张力性水疱；不吻合静脉组患者中有6例(6指)皮瓣因静脉回流障碍而出现张力性水疱，经拆除蒂部部分缝线、换药处理后皮瓣成活。术后随访8～20个月，平均15个月，吻合静脉组患者皮瓣外观满意度评分为(4.6±0.5)分，明显高于不吻合静脉组的(4.3±0.6)分，t＝2.482，P<0.05。吻合静脉组患者皮瓣色素沉着发生率为9%(3/35)，明显低于不吻合静脉组的31%(10/32)，χ(2)＝5.498，P<0.05。 结论： 吻合静脉的带蒂指动脉背侧支岛状皮瓣修复同指指端或指腹缺损，静脉回流通畅，皮瓣色素沉着发生率低、外形美观，患者满意度高。.

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