Abstract:

Objective To investigate the clinical effect of lateral vascular chain flaps with dorsal branches of nerve and digital artery in different donor sites in the repair of finger tip or finger abdomen defects. Methods From June 2017 to April 2021. Forty-nine patients （57 fingers） with the defect of the 2nd to 5th finger end or finger abdomen were repaired with the lateral vessel chain flap of the dorsal branch of digital artery in the emergency department of Tangshan Second Hospital. A prospective research was conducted. The patients were divided into dorsal proximal segment group ［23 cases， 25 fingers， including 13 males and 10 females， with mean age of 37 years （18-55 years）］ and dorsal middle segment group ［26 patients， 32 fingers， including 15 males and 11 females， with mean age of 35 years （20-53 years）］. Intraoperative end-to-end adventitia anastomosis was performed between the cutaneous nerve carried by the flap and the stump of the intrinsic digital nerve in the wound in both groups. The donor site wounds of patients in the two groups were repaired with free full-thickness skin grafts from the proximal forearm or medial upper arm. The blood supply of flaps in the two groups was observed after operation. Sex， age， injury index， side， defect area， flap area，operation time and follow-up time were compared between the two groups. At the last follow-up， static two-point distance perception of the flap was measured. Satisfaction with the appearance of the affected finger flap was evaluated according to Michigan Hand Function Questionnaire. Vancouver Scar Scale was used to evaluate the appearance of the donor site， and the range of motion of metacarpophalangeal and proximal interphalangeal joints were measured. The data were analyzed by using t test or χ² test. Results All flaps and skin grafts survived after operation. No significant differences were found in sex， age， injury index， side， defect area， operation time and follow-up time between the two groups （P > 0.05）， but there was statistical significance in the area of the flap （P < 0.05）. At the last follow-up， the range of motion of metacarpophalangeal and interphalangeal joints in the two groups were significantly higher （P > 0.05）. The satisfaction with the appearance of the affected finger flap， the appearance of the donor site and the static two-point discrimination of the flap in the dorsal middle segment group were significantly better than those in the dorsal proximal segment group （P < 0.05）. Conclusion The flap with the dorsal branch of the proximal or dorsal middle segment as the donor site has the advantage of constant anatomy and simple operation. It is suitable for emergency repair of finger tip or finger abdomen defects， but compared with the dorsal proximal segment group， the dorsal middle segment group has a smaller incision area， better appearance of the injured finger and better feeling of the skin flap.

Key words: surgical flap, finger damage, fingertip defect, finger abdomen defect, dorsal branch of digital artery, nerve anastomosis