Abstract:

Objective

To explore the clinical effect of flap combined with palmaris longus tendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet finger deformity.

Methods

From November 2017 to November 2023， 12 patients （12 fingers） with dorsal digital wound accompanied by mallet finger deformity were admitted to Hand Surgery Department of Suzhou Ruihua Orthopedic Hospital.There were 8 males and 4 females，aged from 21 to 63 years old.The wound areas ranged from 1.5 cm × 1.0 cm to 5.5 cm × 2.0 cm.All the wounds were repaired by the flaps，forearm venous flap with palmaris longus tendon was used in one patient， second toe lateral flaps were used in 6 patients， dorsal digital nerve fasciocutaneous pedicle flaps were used in 4 patients， and free superficial peroneal artery perforator flap was used in one patient.After intraoperative debridement，all patients had tendon defects.The extensor tendon insertion point was reconstructed by folding the palmaris longus tendon in a single-row three-point fixation，and Kirschner wires were implanted for the traction of the interphalangeal joint.Regular follow-up in the outpatient department was conducted， and the Crawford mallet finger efficacy evaluation system was used to evaluate the recovery of finger function during the follow-up.The comprehensive evaluation scale for skin flaps was used to assess the condition of the donor area and recipient area.

Results

All the 12 patients were satisfied with the treatment effect.The wounds healed in one stage.Patients were followed up for 3-15 months，with an average of 7 months.Mallet finger deformity had been corrected， and there was no pain during interphalangeal joint movement.According to the Crawford mallet finger efficacy evaluation system， 8 patients were excellent and 4 patients were good， with an excellent and good rate of 100%.According to the comprehensive evaluation scale for skin flaps， the results were rated as excellent in 9 patients and good in 3 patients， with an excellent and good rate of 100%.The sensation of skin flaps restored to S2-S3.The venous flap had mild pigmentation， the superficial peroneal artery perforator flap had a bulky appearance， which was significantly improved after thinning.The remaining flaps had a good appearance，and the donor area healed in one stage without functional impairment.

Conclusion

The use of skin flap combined with palmaris longus tendon folding single-row three-point fixation for the treatment of dorsal digital wound with mallet finger deformity can achieve good clinical results.

Key words: Surgical procedures, Flap, Mallet fingers, Extensor tendon insertions, Finger injuries