V-Y flap repair of finger-end defects Hui
[Abstract] Objective To investigate the surgical method and clinical efficacy of using V-Y flap to repair finger-end defects. Methods From 2002 to 2009, 46 cases (58 fingers in total) were repaired by V-Y flap in our department, 29 males and 17 females; age ranged from 16 to 52 years, mean 36 years; 15 left-handed cases and 31 right-handed cases; 8 cases had thumb end defects only, 10 cases had index finger end defects only, 11 cases had middle finger end defects only, 8 cases had ring finger end defects only, 6 cases had combined index and middle finger end defects, and 6 cases had combined index, middle and ring finger end defects. Among them, 25 were crush injuries, 22 were cut injuries, and 11 were avulsion injuries; the affected fingers were traumatized on the abdomen or the end of the fingers, and the defect was 0.8×1.0~1.5×2.5 cm; all patients were seen within 6 hours after the injury and received no special treatment before the visit. Results: All cases were followed up from 3 to 12 months, with an average of 7 months. 5 patients (8 fingers) had slightly dull sensation of the flap and no abnormal pain, while the rest had satisfactory recovery of the finger end shape, good sensory recovery, and nearly normal finger joint flexion and extension function. Conclusion The use of V-Y flap for repairing finger-end defects is easy to perform, in line with the principle of proximity of finger-end repair, and the postoperative recovery of sensation, function and shape of the affected finger is ideal, and is suitable for clinical repair of finger-end defect trauma. Luo Yuncang, Department of Orthopedics, Yinshang County People’s Hospital
【Key words】 V-Y flap, finger end defect repair
Finger trauma traumatic defects are clinically common, often with end-joint tissue defects and bone exposure, and finger soft tissue defects are common in hand trauma, mostly accompanied by bone and tendon exposure, which require repair of damaged tendons, blood vessels and nerves in surgical management [1]. There are many methods to repair the trauma, and flap repair is often adopted. The application of flaps to repair end-joint tissue defects and bone exposure is a very important method in the treatment of finger trauma and is extremely important for the restoration of injured finger function [2]. From 2002 to 2009, we applied V-Y flap to repair 46 cases (58 fingers) of end-joint defects with satisfactory surgical results, which are reported as follows.
1. Clinical data and methods
1.1 Case data
There were 46 cases of 58 fingers, 29 males and 17 females; age ranged from 16 to 52 years old, average 36 years old; 15 left-handed cases and 31 right-handed cases; 8 cases with thumb end defects only, 10 cases with index finger end defects only, 11 cases with middle finger end defects only, 8 cases with ring finger end defects only, 6 cases with combined index and middle finger end defects, and 3 cases with combined index, middle and ring finger end defects; among them, 25 cases with crush All patients were seen within 6 hours after the injury and did not receive special treatment before the visit.
1.2 Surgical method
Brachial plexus anesthesia was selected, routine disinfection, wet debridement, and proper hemostasis; contaminated tissue was excised with little or no skin incision. The wound surface was only trimmed with a neat and clean wound; the finger bone stump was trimmed; the “V-Y” flap was designed according to the size of the wound surface, and the size of the flap should be able to wrap around the stump and not be too tight; the finger end defect was repaired, and only the subcutaneous tissue was reached when the triangular flap was cut, and the flap was pushed toward the injured finger stump to protect the blood vessels and nerves during the operation; the skin piece was placed The suture should not be under too much tension to avoid affecting blood circulation; the wound should be routinely dressed after suturing.
1.3 Postoperative care
The affected finger was braked, and the affected limb was kept above the heart, elevated by 10°~15° to maintain the functional position. Postoperative local insulation, routine maintenance of room temperature is sufficient. Observe the distal blood flow of the flap, and deal with any abnormalities in time. Apply antibiotics to prevent wound infection, keep the dressing clean and dry, keep the skin flap draining freely, and remove the skin flap 2 to 3 days after surgery according to the amount and nature of the drainage fluid. Early flexion and extension activities of the healthy finger joints were performed, and functional exercises were performed after one week of braking of the affected finger [3]. The stitches were removed two weeks after surgery.
2. Results
All cases were followed up from 3 to 12 months, with an average of 7 months. 5 patients (8 fingers) had slightly dull sensation of the flap and no abnormal pain, while the rest had satisfactory recovery of the finger end shape, good sensory recovery, and nearly normal finger joint flexion and extension function.
3. Discussion
3.1 Characteristics of the V-Y flap
There are various flaps for fingertip injury repair, and the most commonly used ones are: palmar advancement flap, interphalangeal adjacent flap, V-Y flap, dorsal flap, and lateral island flap of the finger [4]. The main advantages of the local “V-Y” flap compared with other flaps are [5]: (1) after flap repair, the wound is sutured directly with the V-Y method without skin grafting, which makes the operation simpler and avoids secondary surgery; (2) the flap has good blood flow and there is a finger nerve inside the flap, so the postoperative sensory recovery of the affected finger is relatively good, and the shape recovery is still satisfactory; (3) the maximum extent of the flap is still satisfactory. (3) The length of the affected finger was preserved to the greatest extent, and the functional recovery was satisfactory compared with other flap repairs.
The local “V-Y” flap also has shortcomings [6]: (1) insufficient flap peeling may cause curved or hooked nail deformity; (2) the flap repair area is limited, and it is difficult to repair too large a defect, and the flap is prone to ischemic necrosis; (3) the tissue used for repair comes from the affected finger itself, and the affected finger may be thinner than the healthy finger after surgery; (4) because some of the nerves are damaged during flap removal, some patients may experience sensory recovery. Some patients may experience abnormal sensation and pain in the finger.
3.2 Intraoperative and postoperative problems should be noted
The existence of the nail plays an important role in the restoration of the function and appearance of the injured finger, and the regeneration and repair of the nail bed depends on good soft tissue conditions. The V-shaped incision should not cross the joint vertically to prevent postoperative scar contracture [8]; ⑤ Strict postoperative care of the affected limb, pay attention to the survival of the flap [9]; early functional exercise after the survival of the flap, the cases done in our department generally do extension and flexion exercise after 7 days of surgery, and the functional recovery is satisfactory.
In recent years, there are more and more cases of finger trauma, and patients have higher and higher requirements for the surgical results. In clinical work, we should not only consider the shape of the flap and the functional recovery of the finger, but also consider the functional and cosmetic changes of the donor area. The V-Y flap is a simple and easy procedure for repairing finger-end defects, and it is suitable for the repair of finger-end defects in clinical practice because of the ideal sensory, functional, and physical recovery of the affected finger.
References
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[2］ Zhu QS, Zhao GY, Lu YP, et al. Thumb mutilation, amputation repair and replantation of severed fingers. Practical Orthopedics. 3rd edition, 2008. 509-525.
[3] Liang Zicai. V-Y flap with vascular tip for repairing finger end defects. Hainan Medicine, Vol. 18, No. 01, 2007. 77-94.
[4］ Han Fenghua. Application of a modified V-Y advancement flap in end of finger repair. Chinese Journal of Plastic and Burn Surgery, 1987, 3:92.
[5] Zhao Dongfeng, Sun Chengxin, Song Guangen, et al. Modified palmar advancement flap for repair of finger end defects. Chinese Journal of Hand Surgery, 1994, 10:200.
[6] Wu Dingfan. Localized “V-Y” advancement flap for treatment of traumatic end-joint defects of the finger. Chinese Medicine, 2009. 346-347.
[7] Zeng Bo, Yan Mingzhong, Wang Peixin, et al. Application of multiple flaps for repairing post-traumatic finger tissue defects. Journal of Clinical Military Medicine, Vol. 33, No. 2, April 2005, 199-200.
[8] Han Jizhou, Liu Xiaotao, Xiang Xiangjing, et al. 53 cases of finger end injury reconstruction using modified V-Y advancement flap combined with nail bed enlargement. Journal of Clinical and Experimental Medicine, Vol. 8, No. 9, September 2009, 97-98.
[9] Bao Zhengying. Postoperative care of flap transfer for soft tissue defects of the fingers. Journal of Practical Medicine and Technology, Vol. 15, No. 33, November 2008, 4869-4870.