[Combined tissue transplantation for complicated hand injury].
OBJECTIVE
To investigate the effect of combined types in treating cases with 2 to 5 tissues transplantation.


METHODS
305 cases treated from December 1989 to December 2002 were analyzed and summarized. 214 cases were constructed with 2 combined tissues transplantation, the combined types were:toe combined flap,the second toe at both sides transplanted, 2 flaps combined transferred; 75 cases were constructed with 3 combined tissues transplantation, the combined types were: the second toe at both sides combined flap, 2 flaps combined toe, 3 flaps combined transferred; 11 cases were constructed with 4 combined tissues transplantation, the combined types were: 2 flaps combined 2 toes,1 toes combined 3 flaps, 4 flaps combined transferred; 5 cases were constructed with 5 combined tissues transplantation, the combined type was: the wrap flap and the second toe with 1 vascular pedicle and another second toe combined bilateral femoris anterior flaps were transferred. The principles of repair were: the thumb was reconstructed first,the wrap round flap was used for the thumb's skin, the second toe transplantation was used for the thumb defect. The opposite toe was transferred to finger to reconstruct the pinch function. 1 or 2 flaps were selected for repair according to the area of damage. The anterolateral thigh flaps were used for the large areas and the lateral arm flaps were used for the small areas in selecting the donor area.


RESULTS
Of the 722 tissues in 305 cases, 14 of them were necrosis, in which the toe were 6 and the flap were 8,and other transferred tissues all survived, the survival rate of tissue transplantation was 98.1%. 251 cases were followed up for 1 year to 7 years (2. 6 years in average). All the patients could care themselves in daily life. The pinch and opposition functions of the constructed thumbs and fingers were recovered, the two-point discrimination was 6 to 14 mm, but 2 cases recovered adduction function only because the thumb was 6 degree defect without the thenar muscle and did not fix the reconstructed thumb in opposite side in operation. All transplanted flaps recovered protecting sensory with S2, 56 flaps required plastic operation because of their swelling appearance. The donor areas gained primary stage heal in 285 cases, 20 cases gained secondary stage heal, in which part grafted skin necrosis in donor of wrap round flap were 12 cases, the distal of donor big toe necrosis were 2 cases and grafted skin necrosis in donor of anterolateral thigh flap were 8 cases and skin grafted were successful.


CONCLUSIONS
Different combined types can be used according to the traumatic situation. Surgical operation and early rehabilitation is conducive to the final function. Combined tissue transplantation is the best way to repair complicated hand injuries.
Rui
Yongjun
Y
Hand Surgery Hospital of Wuxi, Wuxi Jiangsu, 214062, P. R. China. ruiyj@hotmail.com
Shou
Kuishui
K
Zhang
Quanrong
Q
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps; D016378:Tissue Transplantation / Q000379:methods*; D014034:Toes / Q000637:transplantation; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult