Reconstruction of Allen's type IV fingertip amputation via bilateral unequal-sized hallux osteo-onychocutaneous free flaps: A retrospective study with 5-year follow-up

IF 1.8 4区医学 Q2 ORTHOPEDICS

Chinese Journal of Traumatology Pub Date : 2024-09-14 DOI:10.1016/j.cjtee.2024.09.005

Xiu-Zhong Li , Xiu-Yun Wang , Yi-Min Zhou , Da-Zhi Yu , Hua-Gang Zhang , Shu-Jian Hou , Ke-Cheng Lao , Xiao Fan

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引用次数: 0

Abstract

Purpose

The reconstruction of Allen's type IV fingertip amputation is a clinical challenge. Our team designed bilateral unequal-sized hallux osteo-onychocutaneous free flaps for the long-term reconstruction of Allen's type IV fingertip amputation and conducted a retrospective study with a 5-year follow-up aims to evaluate the effects of this technique.

Methods

A retrospective analysis with a 5-year follow-up including 13 patients with Allen's type IV fingertip amputation who were admitted to our hospital from January 2010 to January 2017 was conducted. The patients were treated with bilateral unequal-sized hallux osteo-onychocutaneous free flaps. The operation time, intraoperative blood loss, and complications were recorded, and the survival rate of the transplanted flaps was calculated. During the 5-year follow-up after operation, the nail growth time was recorded and the finger appearance was observed. At the last follow-up appointment, the length, width, and girth of the reconstructed fingertip and contralateral normal fingertip, range of motion of the reconstructed fingertip and contralateral normal fingertip, Semmes-Weinstein test (for the evaluation of tactile sensation), and two-point discrimination testing results were recorded. SPSS 22.0 software was used for the statistical analysis and the data are presented as mean ± SD.

Results

The mean operation time was (5.62 ± 0.51) h, the mean intraoperative blood loss was (34.15 ± 3.13) mL, and the survival rate of the transplanted flaps was 100%. During the 5-year follow-up, the average nail growth time was (10.14 ± 1.98) months and the average bone union time was (3.78 ± 0.91) months. The length, width, and girth of the reconstructed fingertip were (31.52 ± 3.73) mm, (17.82 ± 1.74) mm, and (59.75 ± 3.04) mm, respectively, which did not differ from those of the contralateral normal fingertip. The range of motion of the reconstructed fingertip was (12.15 ± 2.79) degrees which is different from that of the contralateral normal fingertip. The average tactile sensation evaluated via the Semmes-Weinstein test and the average two-point discrimination test of the reconstructed fingertip were (0.39 ± 0.17) g and (7.46 ± 1.14) mm, respectively, which were not different from those of the contralateral normal fingertip. The average Maryland score of feet in the donor area was 87.66 ± 7.39, which was satisfactory.

Conclusion

Bilateral unequal-sized hallux osteo-onychocutaneous free flaps are an effective method to reconstruct Allen's type IV fingertip amputations with a satisfactory appearance and good sensory function.

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通过双侧大小不等的同侧骨巩膜游离皮瓣重建艾伦第 IV 型指尖截肢：一项为期五年的回顾性研究。

目的：AllenⅣ型指尖截肢的重建是一项临床挑战。我们的团队设计了双侧不等大的同侧骨-腱-皮游离瓣，用于Allen's IV型指尖截肢的长期重建，并进行了一项为期5年的回顾性研究，旨在评估该技术的效果：方法：对我院2010年1月至2017年1月收治的13例Allen's IV型指尖截肢患者进行了为期5年的回顾性分析。这些患者均接受了双侧不等大的指骨骨膜游离皮瓣治疗。记录了手术时间、术中失血量和并发症，并计算了移植皮瓣的存活率。术后 5 年随访期间，记录指甲生长时间并观察手指外观。最后一次复诊时，记录了再造指尖和对侧正常指尖的长度、宽度和周长，再造指尖和对侧正常指尖的活动范围，Semmes-Weinstein 测试（用于评估触觉）和两点辨别测试结果。统计分析采用 SPSS 22.0 软件，数据以均数±标准差表示：平均手术时间为（5.62±0.51）小时，术中平均失血量为（34.15±3.13）毫升，移植皮瓣的存活率为 100%。5 年随访期间，平均指甲生长时间为（10.14 ± 1.98）个月，平均骨结合时间为（3.78 ± 0.91）个月。再造指尖的长度、宽度和周长分别为（31.52±3.73）毫米、（17.82±1.74）毫米和（59.75±3.04）毫米，与对侧正常指尖相比没有差异。重建指尖的活动范围为（12.15 ± 2.79）度，与对侧正常指尖的活动范围不同。通过 Semmes-Weinstein 测试和两点辨别测试评估的重建指尖的平均触觉分别为（0.39 ± 0.17）克和（7.46 ± 1.14）毫米，与对侧正常指尖相比没有差异。供区足的平均马里兰评分为（87.66±7.39）分，结果令人满意：结论：双侧不等大同侧骨髁皮游离瓣是重建Allen's IV型指尖截肢的有效方法，其外观令人满意，且感觉功能良好。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Chinese Journal of Traumatology ORTHOPEDICS-

CiteScore

3.80

自引率

4.80%

发文量

1707

审稿时长

28 weeks

期刊介绍： Chinese Journal of Traumatology (CJT, ISSN 1008-1275) was launched in 1998 and is a peer-reviewed English journal authorized by Chinese Association of Trauma, Chinese Medical Association. It is multidisciplinary and designed to provide the most current and relevant information for both the clinical and basic research in the field of traumatic medicine. CJT primarily publishes expert forums, original papers, case reports and so on. Topics cover trauma system and management, surgical procedures, acute care, rehabilitation, post-traumatic complications, translational medicine, traffic medicine and other related areas. The journal especially emphasizes clinical application, technique, surgical video, guideline, recommendations for more effective surgical approaches.