[Application of venous flow-through flap in finger replantation with circularity soft tissue defect]

To investigate the treatment outcome of applying venous Flow-through flap in the replantation of severed finger with circularity soft tissue defect and vascular defect.

Between January 2010 and December 2012, 11 cases (11 fingers) of severed finger with circularity soft tissue defect and vascular defect underwent replantation with venous Flow-through flaps. There were 8 males and 3 females, aged 18-42 years (mean, 24.6 years). The cause of injury was squeeze injury in 6 cases, crush injury in 3 cases, and strangulation in 2 cases. Combined injuries included nerve defect in 3 cases (1.0, 2.0, and 3.5 cm in length), and tendon defect in 2 cases (2.0 and 6.5 cm in length); cyclic skin and soft tissue defect was 3.0-4.5 cm in width, was 1/2-1 finger circumference in length, and was 2.0 cm x 1.0 cm to 7.0 cm x 4.5 cm in size. Six cases had complete circular defect (both finger artery and vein defects), and 5 cases had incomplete circular defect (only finger artery defect), and vascular defect was 1.0-4.5 cm in length. The time from injury to operation was 1.5-4.5 hours.

Venous crisis occurred in 1 case at 2 days after operation, was cured after vein graft; flap edge necrosis was observed in 2 cases and was cured after dressing change and skin grafting respectively; flap edema and blister occurred in 2 cases and relieved spontaneously. The other 6 flaps and replanted fingers survived completely, with primary healing of incision. Ten cases were followed up 12-18 months (mean, 15.5 months). Only a linear scar was seen at the donor sites, with no functional limitation. The flaps had similar color and texture to adjacent skin. The two-point discrimination was 6.5-13.0 mm (mean, 8.6 mm). According to replanted finger function scoring system of Society of Hand Surgery of Chinese Medical Association, the results were excellent in 6 cases, good in 3 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 90%.

Venous Flow-through flap can repair both vascular defect and soft tissue defect, so it has good outcome in increasing the survival rate of replanted finger for severed finger replantation with circularity soft tissue defect and vascular defect.