Clinical application and evaluation of the improved reverse homodigital island flap

Objective To explore the method of preparing the improved retrograde inherent arterial island flap and evaluate its clinical efficacy for the defect of finger distal segment. Methods The clinical data of 11 patients undergoing repair of finger distal segment defect with the improved methods for reverse homodigital island flap in our hospital between January, 2016 and December, 2016 were reviewed. The reverse homodigital island flaps were from 1.0 cm ×1.5 cm to 2.5 cm × 2.5 cm in size. The flap ran along the axis of arterial and nerve, with the two boundaries not more than the midpoint of the dorsal of the hand, and the rotation point was marked by a quarter of the central phalange. The microscopic equipment separation was used to prepare the skin flap under the microscope. The natural surface of neural tissue was separated to make its free as the flap approached the midpoint of digital pulp, and the proper digital arteries and accompanying venous network were then indirectly isolated. The subcutaneous soft tissue in the flap area was sutured for 2 stitches to cover the exposed nerve, and the carpometacarpal full thickness graft was used to suture the skin area directly. Gypsum was used for the fixation and protection at wrist flexion for one week. The planting bags were removed one week after the surgery to promote the functional exercise in flexion and extension. After 6 months of follow-up, the patients were evaluated for their functions and appearance. Results All of the 11 cases of flaps survived without venous or arterial crisis. Postoperative follow-up showed that the appearance of the repaired finger was similar to normal finger, with satisfied sensation and movement function. Conclusion The improved reverse homodigital island flap for the defect of finger distal segment is easy to operate, which can shorten the operation time, ensure the safety of surgery (flap survival). It can effectively protect the proper digital arteries and accompanying venous network in the preparation of the flap, avoid the venous or arterial crisis, with satisfied appearance and function and minor injury, which is an ideal operation method for the repair of finger.