[Replantation of complex thumb mutilation with local island flap]

To investigate the clinical effect and operative method of local island flap for complex thumb mutilation with soft tissue and blood vessel defect.

From May 2003 to March 2006, 6 cases of complex thumb mutilation with soft tissue and blood vessel defect were treated with local island flap. There were 4 males and 2 females aged 14-48 years, with an average of 23.5 years, among whom 2 cases were caused by triangular bandage twist, 3 cases by machines avulsion and 1 case by explosion. Five cases suffered thumb mutilation of soft and blood vessel defect only, and 1 case was combined with middle and ring finger injures. The defect was located in pulp soft tissue in 4 cases and in dorsal soft tissue in 2 cases, ranging 2.0 cm x 1.2 cm-2.5 cm x 1.8 cm in size. The time from injury to operation varied from 30 minutes to 6 hours. Two cases were replanted with bridging index finger radialis digital artery island, 2 cases were repaired by ring finger radialis digital artery island and 2 cases by index finger near dorsi-flap. The flap was 2.0 cm x 1.4 cm-2.5 cm x 1.8 cm in size. Free-skin graft from forearm was conducted.

All flaps free skin and replanted thumbs in 6 cases survived completely, following up for 6-24 months after operation. The flaps and thumb had good texture and color match, two-point discrimination was 10-12 mm on thumb pulp and 8-10 mm on flap. All replanted thumb recovered satisfied function, there were no donor site dysfunction. According to the criteria for function assessment of amputated finger issued by the Branch of Hand Surgery of Chinese Medicine Association: 4 cases were regarded as excellent and 2 as good.

Local island flap is capable of repairing complex thumb mutilation with soft tissue and blood vessel defect, maximizing the recovery of thumb appearance and function.