[Forward homodigital ulnaris artery flap coverage for bone and nail bed graft in thumb fingertip amputation]

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 May; 23(5): 581-3Zhou X, Xu Y, Rui Y, Shou K, Yao QOBJECTIVE: To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. METHODS: From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients' (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distal one third of nail bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm x 1.4 cm to 2.0 cm x 1.4 cm. RESULTS: All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swelling. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the healing time was 4-5 weeks. All finger nails were smooth and flat without pain. CONCLUSION: When there was no indication of replantation in thumb fingertip amputation, establishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graft.