Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb

Wang Hui; Yang Xiaoxi; Huo Yongxin; Hao Ruizheng; Chang Hong; Liu Wei; Wang Bin

doi:10.3760/cma.j.cn501120-20200607-00298

Volume 37 Issue 8

Aug. 2021

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2021 > 37(8): 758-763

Wang H,Yang XX,Huo YX,et al.Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb[J].Chin J Burns,2021,37(8):758-763.DOI: 10.3760/cma.j.cn501120-20200607-00298.

Citation:

PDF( 2423 KB)

Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb

doi: 10.3760/cma.j.cn501120-20200607-00298

1.
Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan 063000, China
2.
College of Traditional Chinese Medicine, North China University of Science and Technology, Tangshan 063210, China

Funds:

High-level Talent Support Project of Hebei Province of China A201901124

Medical Science and Research Project Plan of Hebei Province of China 20201453

Tracking Project of Medical Applicable Technology in Hebei Province of China GZ2021030

Science and Technology Self-financing Project of Hebei Province of China 182777137

More Information

Corresponding author: Wang Hui, Email: wanghuiyxx@163.com
Received Date: 2020-06-07

Abstract

Abstract

Objective To investigate the clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb. Methods A retrospective observational study was conducted. From February 2016 to April 2019, a total of 21 patients (21 fingers) with finger tip or finger pulp wounds of the thumbs met the inclusion criteria and were admitted to the Second Hospital of Tangshan, including 13 males and 8 females, aged 21 to 65 years, with the defects located at the finger tips of 14 patients and the finger pulps of 7 patients, and all having exposed bones and/or tendons. The wound sizes of patients in this group after debridement ranged from 2.0 cm×1.5 cm to 4.0 cm×2.7 cm. All the wounds were repaired with the neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve, with the flap sizes ranging from 2.3 cm×1.8 cm to 4.3 cm×3.0 cm. In surgery, the terminal branch of lateral antebrachial cutaneous nerve carried by the flaps was anastomosed with the end of the proper digital nerve of the wounds. The donor sites of flaps were sutured directly. The survival of flaps and healing of wounds in donor sites after operation were observed. The appearance of flaps and donor sites were observed during follow-up. At the final follow-up, the static two-point discrimination distances of the flaps were measured, and the degree of satisfaction of patients for the appearances of injured hands were evaluated based on Michigan Hand Function Questionnaire. The total action motion (TAM) of the injured and contralateral thumbs and the angle of thumb web of the injured and contralateral hands were measured. Data were statistically analyzed with paired sample t test. Results All the flaps of the 21 patients survived with good blood supply and no infection. The wounds at the donor sites were all healed. All the patients were followed up, with the time ranging from 8 to 22 months. The appearances of flaps were good with their color and texture similar to the surrounding tissue. There was no pain in the finger tip or finger pulp, nor any ectopic sensation in flaps. There was only some linear scar left at the radial side of thumb. At the final follow-up, the static two-point discrimination distances of the flaps of the patients were 6 to 11 mm; 18 patients were very satisfied and 3 patients were satisfied with the overall appearance of the injured hand. The TAM of injured thumbs and the angle of thumb web of the injured hands of the patients were respectively (140±5)º and (94±9)°, which were similar to (141±5)º of the thumbs and (95±9)° of hands in the contralateral side, respectively (t=-2.024, -1.142, P>0.05). Conclusions The neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve has constant anatomy and is easy to perform. It can repair the finger tip or finger pulp wounds of the thumb achieving good appearance and function recovery. It provides a good option for repair of finger tip or finger pulp wounds of the thumb and is especially suitable for emergency application.
- Surgical flaps,
- Thumb,
- Finger injuries,
- Neurocutaneous vascular flaps,
- Lateral antebrachial cutaneous nerve,
- Wound repair

FullText(HTML)

References(37)

References

[1]	张世民,徐达传. 带皮神经及其营养血管的皮瓣[J]. 中国临床解剖学杂志, 1996, 14(4):313-315.DOI: 10.13418/j.issn.1001-165x.1996.04.039.
[2]	钟世镇, 徐永清, 周长满, 等. 皮神经营养血管皮瓣解剖基础及命名[J]. 中华显微外科杂志, 1999, 22(1):37-39. DOI: 10.3760/cma.j.issn.1001-2036.1999.01.014.
[3]	齐杰,李雯,刘艳杰,等.前臂外侧皮神经营养血管逆行蒂岛状皮瓣修复手背软组织缺损[J].中华整形外科杂志,2010,26(4):241-243.DOI: 10.3760/cma.j.issn.1009-4598.2010.04.001.
[4]	邹锦考,邓国权,莫凤莲,等.前臂外侧皮神经营养血管皮瓣的临床应用[J].中华显微外科杂志,2014,37(4):398-399.DOI: 10.3760/cma.j.issn.1001-2036.2014.04.027.
[5]	谢艾玲,张荐,卢爱东,等.逆行前臂外侧皮神经营养血管筋膜蒂皮瓣修复手部皮肤缺损[J].中国修复重建外科杂志,2014,28(12):1498-1501.DOI: 10.7507/1002-1892.20140324.
[6]	李慧,魏在荣,杨胜波.前臂皮神经营养血管皮瓣解剖学基础与感觉重建临床应用进展[J].解剖学杂志,2019,42(1):74-77.DOI: 10.3969/j.issn.1001-1633.2019.01.019.
[7]	LiH,ZhuWW,WuSW,et al.Anatomical analysis of antebrachial cutaneous nerve distribution pattern and its clinical implications for sensory reconstruction[J].PLoS One,2019,14(9):e0222335.DOI: 10.1371/journal.pone.0222335.
[8]	KanchanathepsakT, RojpitipongsakornC, TawonsawatrukT, et al. The lateral antebrachial neurocutaneous flap: a cadaveric study and clinical applications [J]. J Reconstr Microsurg, 2020, 36(7):541-548. DOI: 10.1055/s-0040-1710551.
[9]	LucchinaS,FusettiC,LazzaroL,et al. End-to-side innervated sensate radial forearm flap in the hand: a 5-year follow-up[J].Hand Surg Rehabil,2019,38(3):207-210.DOI: 10.1016/j.hansur.2019.03.005.
[10]	ChungKC,PillsburyMS,WaltersMR,et al.Reliability and validity testing of the Michigan Hand Outcomes Questionnaire[J].J Hand Surg Am,1998,23(4):575-587.DOI: 10.1016/S0363-5023(98)80042-7.
[11]	BrambulloT, Dalla VeneziaE, VindigniV,et al. Extended Hueston flap: new solution for primary closure[J]. J Hand Microsurg, 2018, 10(3):155-157. DOI: 10.1055/s-0038-1636833.
[12]	CuiMY, WangPJ. Fingertip reconstruction using a lateral flap based on the distal transverse arch of the digital artery[J]. Ann Plast Surg, 2020, 84(5S Suppl 3):S186-189. DOI: 10.1097/SAP.0000000000002370.
[13]	WangH,ChenC,LiJ,et al.Modified first dorsal metacarpal artery island flap for sensory reconstruction of thumb pulp defects[J].J Hand Surg Eur Vol,2016,41(2):177-184.DOI: 10.1177/1753193415610529.
[14]	池征璘,陈一衡,罗鹏,等.改良示指背侧岛状皮瓣修复拇指指端软组织缺损[J].中华显微外科杂志,2019,42(3):228-231.DOI: 10.3760/cma.j.issn.1001-2036.2019.03.005.
[15]	TorosT,GurbuzY,KelesogluB,et al.Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger[J].J Hand Surg Eur Vol,2018,43(10):1036-1043.DOI: 10.1177/1753193418778447.
[16]	González PortoSA, Postigo MarcosEB, Fernández MarcosAA, et al. First dorsal metacarpal flap refinement for coverage of thumb defects[J]. J Plast Reconstr Aesthet Surg, 2019, 72(2):335-354. DOI: 10.1016/j.bjps.2018.11.016.
[17]	HuDQ,WeiZR,WangTQ,et al.Anatomical basis and clinical application of the dorsal perforator flap based on the palmar artery in the first web[J].Surg Radiol Anat,2020,42(3):269-276.DOI: 10.1007/s00276-019-02376-8.
[18]	ShubinetsV, ElliottRM. Ulnar thumb pulp reconstruction using the anterograde homodigital neurovascular island flap[J]. J Hand Surg Am, 2018, 43(1):89.e1-89.e7. DOI: 10.1016/j.jhsa.2017.10.013.
[19]	LiuHJ, RegmiS, HeYY, et al. Thumb tip defect reconstruction using neurovascular island pedicle flap obtained from long finger[J]. Aesthetic Plast Surg, 2016, 40(5):755-760. DOI: 10.1007/s00266-016-0674-1.
[20]	WangH,YangXX,ChenC,et al. Modified Littler flap for sensory reconstruction of large thumb pulp defects[J].J Hand Surg Eur Vol,2018,43(5):546-553.DOI: 10.1177/1753193417754191.
[21]	刘刚义,郑龙,刘宗义,等.拇指背皮神经营养血管皮瓣修复拇指远端软组织缺损[J].中华显微外科杂志,2017,40(4):342-344.DOI: 10.3760/cma.j.issn.1001-2036.2017.04.008.
[22]	FanAW, SongLH, ZhangHL, et al. Reconstruction of finger pulp defects with an innervated distally-based neurovascular flap[J]. J Hand Surg Am, 2020, 45(5):454.e1-454.e8. DOI: 10.1016/j.jhsa.2019.10.018.
[23]	MaoT,XieRG,WangGH,et al.Application of a modified dorsoulnar artery pedicle flap in the repair of thumb tip defects: a case report[J].Exp Ther Med,2020,19(5):3300-3304.DOI: 10.3892/etm.2020.8583.
[24]	QinHJ,MaT,XiaJ,et al. Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle[J].Arch Orthop Trauma Surg,2020,140(7):987-992.DOI: 10.1007/s00402-020-03467-7.
[25]	万强, 赵云珍, 赵岩. 缝接神经的带蒂顺行指掌侧固有动脉皮瓣修复拇指软组织缺损[J]. 中华显微外科杂志, 2019, 42(6):584-587. DOI: 10.3760/cma.j.issn.1001-2036.2019.06.018.
[26]	孙海军,兰登哲,孙同新,等.不同皮瓣修复拇指指端软组织缺损疗效观察[J].中华手外科杂志,2018,34(1):53-54.DOI: 10.3760/cma.j.issn.1005-054X.2018.01.022.
[27]	CherubinoM, CornoM, ValdattaL, et al. Thumb reconstruction with thin proximal ulnar perforator free flap[J]. J Hand Surg Am, 2017, 42(2):e133-e138. DOI: 10.1016/j.jhsa.2016.11.026.
[28]	孙鹏,战杰,王思夏.游离尺动脉腕上皮支上行穿支皮瓣修复拇指软组织缺损[J].中华显微外科杂志,2019,42(2):187-189.DOI: 10.3760/cma.j.issn.1001-2036.2019.02.023.
[29]	晏桂明,王小立,刘宏国,等.𧿹趾腓侧游离皮瓣修复拇指和手指掌侧软组织缺损的临床经验[J].中华显微外科杂志,2018,41(6):589-591.DOI: 10.3760/cma.j.issn.1001-2036.2018.06.020.
[30]	UsamiS, InamiK, HiraseY, et al. An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction[J]. J Hand Surg Eur Vol, 2020, 45(8):842-848. DOI: 10.1177/1753193420939379.
[31]	ZhaoXF, GuoJ, DingJY, et al. Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects[J]. Med Hypotheses, 2020, 134:109435. DOI: 10.1016/j.mehy.2019.109435.
[32]	KodairaS, FukumotoK. Use of distal hypothenar perforator free flaps for pulp defects[J]. J Hand Surg Asian Pac Vol, 2020, 25(1):20-25. DOI: 10.1142/S2424835520500022.
[33]	KubotaY, MitsukawaN, ChumaK, et al. Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting[J/OL]. Burns Trauma, 2016, 4:9[2020-06-07]. https://pubmed.ncbi.nlm.nih.gov/27574679. DOI: 10.1186/s41038-016-0039-7.
[34]	BertelliJA, KhouryZ. Neurocutaneous island flaps in the hand: anatomical basis and preliminary results[J]. Br J Plast Surg, 1992, 45(8):586-590. DOI: 10.1016/0007-1226(92)90024-r.
[35]	MasqueletAC, RomanaMC, WolfG. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg[J]. Plast Reconstr Surg, 1992, 89(6):1115-1121. DOI: 10.1097/00006534-199206000-00018.
[36]	周莉萍, 张文浩, 王玉龙. 远位埋没缝合切口减张技术联合电子线照射治疗瘢痕疙瘩九例[J]. 中华整形外科杂志, 2019, 35(3):278-281. DOI: 10.3760/cma.j.issn.1009-4598.2019.03.013.
[37]	OgawaR. Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL]. Burns Trauma, 2019, 7:7[2020-06-07]. https://pubmed.ncbi.nlm.nih.gov/30891462/.DOI: 10.1186/s41038-019-0144-5.

Relative Articles

[1]	Zheng Yun, Cheng Liangkun, Cui Liuchao, Tan Yuzhong, Tian Lin. Clinical effects of free dorsal interosseous artery perforator flaps in repairing multi-finger skin and soft tissue defects[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(5): 476-481. doi: 10.3760/cma.j.cn501225-20231130-00221
[2]	Wu Haibo, Jin Guangzhe, Li Jin, Zhang Yan, Wang Kai, Wang Qiang, Tang Xiaoqiang, Ju Jihui, Hou Ruixing. Effects of the first dorsal metatarsal artery terminal branch flaps in repairing skin and soft tissue defects of fingers[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(10): 963-970. doi: 10.3760/cma.j.cn501225-20231226-00271
[3]	Chen Yan, Xie Bin, Liu Yuanjun, Wu Jian. Effects of the second dorsal metacarpal artery perforator flap relaying the dorsal island flap of index finger in repairing thumb wounds[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(10): 971-977. doi: 10.3760/cma.j.cn501225-20231202-00224
[4]	Wang Hui, Zhou Tong, Liu Yujie, Zhang Yihan, Liu Ying, Ma Tiepeng, Yang Xiaoxi. Effects of four types of perforator flaps pedicled with cutaneous neurotrophic vessels in repairing wounds on the volar side of hands[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(11): 1038-1046. doi: 10.3760/cma.j.cn501225-20230720-00009
[5]	Xue Jidong, Di Haiping, Liang Yan, Xing Peipeng, Guo Haina, Zhao Xiaokai, Wang Limin, Xia Chengde. Curative effects of foot microflap free transplantation in the repair of full-thickness electric burn wounds deep to tendon or even bone in fingers[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(8): 724-730. doi: 10.3760/cma.j.cn501225-20230323-00094
[6]	Xing Peipeng, Mu Xinling, Xia Chengde, Shi Jijing, Xue Jidong, Yang Gaoyuan, Zhang Jian, Di Haiping. Clinical effects of free hallux-nail flap combined with the second toe composite tissue flap in the reconstruction of damaged thumb after electrical burns[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(7): 677-682. doi: 10.3760/cma.j.cn501120-20210621-00222
[7]	Zhang Yujun, Ju Jihui, Zhao Qiang, Wang Benyuan, Cheng Heyun, Wang Guiyang, Hou Ruixing. Clinical effects of proximal ulnar artery perforator flap combined with iliac bone graft in the reconstruction of subtotal thumb or finger defects[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(10): 959-963. doi: 10.3760/cma.j.cn501120-20210707-00238
[8]	Wang Hui, Yang Xiaoxi, Liu Bingbing, Huo Yongxin, An Xiaofei, Yang Shanhui, Wang Bin. Effects of three kinds of proximal pedicled flaps of hand for relaying repair of degloving injuries of fingertips and the soft tissue defects in the donor sites[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(1): 64-69. doi: 10.3760/cma.j.cn501120-20200103-00001
[9]	Yang Tao, Chen Jia, Cheng Beibei, Wang Shuai, Jiang Xiaomeng, Song Li, Zhou Mingwu, Li Shimin. Clinical effect of perforator flap combined with toe transplantation for repairing thumb damage with soft tissue defect of hand[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(9): 875-879. doi: 10.3760/cma.j.cn501120-20200727-00360
[10]	Wang Yanling, Chang Yan, Li Sanliang, Wang Jianguo. Methods and effects of high-frequency color Doppler ultrasound assisted reverse island flap of dorsal digital artery of ulnar thumb for repairing skin and soft tissue defects in the distal end of the same finger[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(6): 555-561. doi: 10.3760/cma.j.cn501120-20210223-00063
[14]	Chang Shusen, Jin Wenhu, Wei Zairong, Sun Guangfeng, Wang Bo, Deng Chengliang, Tang Xiujun, Zeng Xueqin, Nie Kaiyu. Repair of skin and soft tissue defects at distal end of finger with serrated flap with digital proper artery and nerve pedicle combined with bilaterally pedicled V-Y advancement flap of the injured finger[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(4): 204-207. doi: 10.3760/cma.j.issn.1009-2587.2016.04.004
[17]	Zhu Haitao, Cao Yujue, Wan Lin, Jiang Jiulong. Repair of deep wound on thumb using island flap from dorsoulnar side of thumb[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2014, 30(5): 405-407. doi: 10.3760/cma.j.issn.1009-2587.2014.05.006
[20]	WANG De-yun, XIE Wei-guo, WANG Li-fang, ZHANG Wei, LIU Jie-feng, CHEN Kang. Application of reverse island flaps pedicled with cutaneous nerve nutrient vessels to repair defect on distal parts of extremities[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2007, 23(5): 356-358.

Supplements(0)

Cited By

Cited by

Periodical cited type(7)

1.	张一晗，王红涛，王海峰，贾鑫玮，王辉. 皮神经营养血管皮瓣术后色素沉着的相关因素. 中国矫形外科杂志. 2024(13): 1194-1198 .
2.	王海峰，张一晗，孙鑫洋，王辉，戴江平. 高频彩色多普勒超声辅助桡动脉穿支蒂前臂外侧皮神经营养血管皮瓣修复肘部以远软组织缺损. 中华整形外科杂志. 2024(09): 963-969 .
3.	王辉，周彤，刘玉杰，张一晗，刘英，马铁鹏，杨晓溪. 四种皮神经营养血管带蒂穿支皮瓣修复手部掌侧创面的效果. 中华烧伤与创面修复杂志. 2023(11): 1038-1046 . 本站查看
4.	赵一霖，靳美玲，马丹丹. 局部推进皮瓣修复治疗对拇指指端缺损的效果及对患者心理状态的影响. 中国医疗美容. 2023(12): 33-36 .
5.	朱前进. 皮瓣修复术治疗手部烧伤缺损的效果及安全性. 医药论坛杂志. 2022(14): 46-50 .
6.	王辉，杨晓溪，霍永鑫，郝睿峥，杨山辉，张万喜. 双皮神经吻合局部带蒂皮瓣修复拇指缺损. 中国矫形外科杂志. 2022(18): 1689-1692 .
7.	李启朝，姜素平，李根群，胡轶婷，李国增，张焕宁，郭超，夏男男. 拇指桡侧指动脉逆行近节背侧皮瓣修复拇指指端缺损. 中华创伤杂志. 2021(11): 984-989 .

Other cited types(1)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(1)

Get Citation

PDF

XML

Article Metrics

Article views (236) PDF downloads(18)

Clinical effects of neurocutaneous vascular flap innervated by terminal branch of lateral antebrachial cutaneous nerve in repairing finger tip or finger pulp wounds of the thumb

doi: 10.3760/cma.j.cn501120-20200607-00298