Introduction
Materials and methods
General information
Case | Age | Sex | Injured finger | Injury type | Defect size(cm) | Flap size(cm) | Operation time(min) | Follow-up(month) |
---|---|---|---|---|---|---|---|---|
1 | 25 | M | RMARF | thermal compression injuries | 1.7 × 1.6/ 2.0 × 1.6 | 1.9 × 1.8/ 2.2 × 1.8 | 185 | 8 |
2 | 53 | M | LMARF | machine crush injuries | 3.6 × 1.5/3.0 × 1.8 | 3.8 × 1.7/3.2 × 2.0 | 210 | 7 |
3 | 52 | F | RMARF | cut | 2.2 × 1.6/1.9 × 1.8 | 2.4 × 1.8/2.1 × 2.0 | 195 | 10 |
4 | 54 | F | LMARF | thermal compression injuries | 1.9 × 1.4/ 2.8 × 1.8 | 2.1 × 1.6/ 3.0 × 2.0 | 190 | 12 |
5 | 51 | F | LMARF | machine crush injuries | 4.8 × 2.3/ 4.6 × 2.6 | 5.0 × 2.5/ 4.8 × 2.8 | 215 | 14 |
6 | 41 | M | RMAIF | machine crush injuries | 3.4 × 2.6/ 2.7 × 2.3 | 3.8 × 2.8/ 3.5 × 2.5 | 190 | 7 |
7 | 52 | M | LMARF | thermal compression injuries | 1.8 × 1.5/1.9 × 1.6 | 2.0 × 1.7/2.1 × 1.8 | 180 | 10 |
8 | 45 | F | LMARF | machine crush injuries | 3.5 × 2.0/ 3.2 × 1.8 | 3.7 × 2.2/ 3.6 × 2.0 | 200 | 20 |
9 | 56 | F | RMAIF | machine crush injuries | 4.7 × 3.0/ 4.2 × 2.8 | 4.9 × 3.2/ 4.4 × 3.0 | 200 | 9 |
10 | 37 | M | LMARF | cut | 2.4 × 1.4/1.8 × 1.8 | 2.6 × 1.6/2.0 × 2.0 | 215 | 11 |
11 | 43 | M | RMARF | cut | 3.0 × 1.7/4.2 × 2.4 | 3.2 × 1.9/4.4 × 2.6 | 210 | 22 |
12 | 36 | M | LRALF | machine crush injuries | 4.4 × 2.6/4.2 × 1.5 | 4.6 × 2.8/4.4 × 1.7 | 185 | 8 |
13 | 38 | M | LMAIF | machine crush injuries | 4.4 × 1.4/ 4.0 × 1.5 | 4.6 × 1.6/4.2 × 1.7 | 230 | 18 |
14 | 32 | F | RMARF | machine crush injuries | 2.2 × 1.6/2.0 × 1.6 | 2.4 × 1.8/2.2 × 1.8 | 190 | 12 |
15 | 48 | F | LMAIF | thermal compression injuries | 1.9 × 1.9/2.0 × 1.8 | 2.1 × 2.1/2.2 × 2.0 | 180 | 10 |
16 | 49 | M | LMARF | machine crush injuries | 4.0 × 2.1/ 3.8 × 1.8 | 4.2 × 2.3/4.0 × 2.0 | 190 | 9 |
17 | 55 | M | LMARF | machine crush injuries | 3.4 × 1.9/ 3.2 × 1.8 | 3.6 × 2.1/3.4 × 2.0 | 210 | 9 |
18 | 53 | F | RMARF | machine crush injuries | 3.0 × 2.0/ 4.0 × 1.5 | 3.2 × 2.2/4.2 × 1.7 | 200 | 17 |
19 | 40 | F | RMARF | cut | 3.0 × 1.7/4.2 × 2.4 | 3.2 × 1.9/4.4 × 2.6 | 190 | 14 |
20 | 35 | M | LMAIF | thermal compression injuries | 2.6 × 1.8/ 2.8 × 1.9 | 2.8 × 2.0/ 3.0 × 2.1 | 180 | 19 |
21 | 58 | M | LMAIF | machine crush injuries | 3.8 × 1.7/3.2 × 2.0 | 4.0 × 1.9/3.4 × 2.2 | 190 | 10 |
Cell scaffold
Inclusion criteria
Exclusion criteria
Surgical treatment procedure
Flap design and cutting
Treatment of the foot donor area
Flap transfer process
Postoperative treatment
Observation index and evaluation method
Results
Reconstructed | Donor | ||||||||
---|---|---|---|---|---|---|---|---|---|
Case | MHOQ (score) | DFE | 2PD(mm) | CISS | Pain(VAS) | 2PD(mm) | Pain(VAS) | C- MFPDI(score) | |
Function | Appearance | Great / 2nd | |||||||
1 | 85 | 81.25 | Excellent/Excellent | 4/5 | Mild | 0 | 9/10 | 0 | 51 |
2 | 90 | 75 | Excellent/Excellent | 5/5 | Mild | 0 | 7/8 | 0 | 51 |
3 | 80 | 87.5 | Excellent/Good | 6/7 | Mild | 0 | 8/7 | 0 | 51 |
4 | 85 | 87.5 | Good/Excellent | 8/5 | Mild | 0 | 7/6 | 0 | 51 |
5 | 85 | 93.75 | Excellent/Good | 6/7 | Mild | 0 | 7/8 | 0 | 51 |
6 | 95 | 81.25 | Excellent/Excellent | 6/5 | Mild | 0 | 9/7 | 0 | 51 |
7 | 80 | 81.25 | Excellent/Excellent | 6/5 | Mild | 0 | 10/9 | 0 | 51 |
8 | 95 | 81.25 | Excellent/Excellent | 6/7 | Mild | 0 | 8/8 | 0 | 51 |
9 | 75 | 75 | Good/General | 7/6 | Mild | 0 | 7/8 | 0 | 51 |
10 | 80 | 87.5 | Excellent/Excellent | 4/6 | Mild | 0 | 8/6 | 0 | 51 |
11 | 90 | 81.5 | Excellent/Excellent | 7/5 | Mild | 0 | 10/8 | 0 | 51 |
12 | 80 | 93.75 | Excellent/Excellent | 5/7 | Mild | 0 | 9/7 | 0 | 51 |
13 | 75 | 81.25 | Good/Good | 7/9 | Mild | 0 | 8/9 | 0 | 51 |
14 | 95 | 75 | Excellent/Excellent | 6/5 | Mild | 0 | 7/8 | 0 | 51 |
15 | 90 | 87.5 | Excellent/Excellent | 4/5 | Mild | 0 | 8/9 | 0 | 51 |
16 | 95 | 93.75 | Excellent/Excellent | 4/5 | Mild | 0 | 9/10 | 0 | 51 |
17 | 90 | 87.5 | Excellent/Excellent | 5/6 | Mild | 0 | 8/10 | 0 | 51 |
18 | 85 | 87.5 | Excellent/Good | 5/4 | Mild | 0 | 10/8 | 0 | 51 |
19 | 80 | 81.25 | Excellent/Good | 6/6 | Mild | 0 | 7/9 | 0 | 51 |
20 | 90 | 93.75 | Excellent/Excellent | 7/5 | Mild | 0 | 10/7 | 0 | 51 |
21 | 90 | 81.25 | Excellent/Excellent | 6/8 | Mild | 0 | 8/8 | 0 | 51 |
Discussion
Structure of the fingers
Research status of flap repair for finger defects
Flap from the foot is used to repair finger defects
Surgical exploration
Mechanism of action of the cell scaffold
Advantages and disadvantages of surgery
Advantages
Disadvantages
Advantages | Disadvantage |
---|---|
1. Using a bilobed flap for adjacent finger trauma reduces surgical complexity by requiring fewer blood vessel connections. 2. The length of the exposed vessel pedicle between the flaps allows for finger movement and helps prevent damage to the vascular pedicle. 3. Rapid granulation tissue growth in the donor area after covering the cell scaffold improves repair without the need for toe amputation or additional flap repair. 4. The narrow vascular pedicle between the flaps allows for easy trimming, resulting in aesthetically pleasing and functional fingers. 5. Nerve anastomosis provides satisfactory sensation restoration. | 1. The blood vessel pedicle between the flaps needs to be cut twice. 2. The cell scaffold is costly and requires a second skin grafting surgery. 3. The vascular pedicle, although longer, cannot fully support normal finger movement, potentially causing temporary syndactylization. 4. Harvesting the first dorsal (plantar) metatarsal artery reduces the possibility of same-side toe transfer due to vascular deficiency during toe transplantation. |
Intraoperative and postoperative points
POINTS |
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(1) Stop bleeding in the donor area, rinse the wound with saline, and maintain sterility in the surgical area. |
(2) For larger wounds, compress the cell scaffold to ensure good contact with the wound. |
(3) Skin graft should be done 3 weeks after phase I surgery, when granulation tissue is sufficient and turns from dark red to pink. |
(4) After 7–9 days post-surgery, instruct patients to perform finger exercises for joint recovery. |