Disruption of Nerve Repair, Infection Wound
Conditions
Keywords
defect;, dorsal branch of the proper digital nerve;, proper digital nerve;, finger sensory reconstruction.
Brief summary
A combination of soft tissue and digital nerve defects in the finger results in sensory loss of the finger pulp. Reconstruction of these combined injuries is difficult. When the neurocutaneous defect is associated with wound infection, reconstructive alternatives are more limited. From July 2008 to May 2010, a retrospective study was conducted with 9 consecutive postinfection patients who had the neurocutaneous defect of the finger following trauma. The purpose of this retrospective study is to report repair of the complicated infected wound in the finger using the bipedicled nerve flap and to evaluate the efficacy of this technique.
Detailed description
sensation of the flaps is assessed using static two-point discrimination (2PD) and Semmes-Weinstein monofilament (SWM) testing at final follow-up. The cold intolerance of the injured finger is measured using the self-administered Cold Intolerance Severity Score questionnaire that was rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100). Patients report their satisfaction with functional recovery of the injured finger according to the Michigan Hand Outcomes Questionnaire that was based on a 5-point response scale.
Interventions
DEVICENerve flap
Based on the Teoh et al.'s technique, we combined the nerve graft into the bipedicled heterodigital arterialized island flap and used this composite flap tissue for reconstructing complicated infected wound in the finger.
Sponsors
The Second Hospital of Tangshan
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
16 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
* an infective wound with exposed bone or tendon in the finger; * soft tissue defect involving proximal half of the middle phalanx, the proximal phalanx, or both; * associated digital nerve defect 1 to 4 cm in length; * single or double nerve defects; and * simultaneous repair of nerve and soft tissue defects.
Exclusion criteria
* injury to the course of the pedicle or the donor site; * nerve defect less than 1 cm or larger than 4 cm in length; * occurrence of the defect in a region the flap is unable to reach, such as distal interphalangeal joint region, distal portion of the middle phalanx of the middle finger and the thumb; * no involvement of the digital nerve.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 2-point Discrimination Test | 17-25 months | The 2-point Discrimination Test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent \<6 mm; good 6-10 mm; fair 11-15 mm; poor \>15 mm. The test points were at the center of the radial or ulnar portion of the pulp. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stopped at 4 mm as a limit of 2PD and considered this normal. The assessments were performed at a single time point at the final follow up. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Semmes-Weinstein (SW) Monofilament Test | 17-25 months | The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Pain | 17-25 months | Pain was given subjectively by the patient using the visual analogue scale (VAS). The VAS consists of a 10 cm line that was grouped into mild (1-3 cm), moderate (4-6 cm) and severe (7-10 cm). |
Countries
China
Participant flow
Recruitment details
From July 2008 to May 2010, 9 patients who had a combination of soft tissue and digital nerve defects were included in the study. The type of location was medical clinic.
Pre-assignment details
No patient was lost to follow-up
Participants by arm
| Arm | Count |
|---|---|
| Nerve Graft Simultaneous repair of the infected wound and digital nerve defect in the finger using a bipedicled nerve flap including nerve graft from the dorsal branch of the digital nerve. | 9 |
| Total | 9 |
Baseline characteristics
| Characteristic | Nerve Graft |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 9 Participants |
| Age, Continuous | 32.6 years STANDARD_DEVIATION 6.6 |
| Region of Enrollment China | 9 participants |
| Sex: Female, Male Female | 3 Participants |
| Sex: Female, Male Male | 6 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 9 |
| serious Total, serious adverse events | 0 / 9 |
Outcome results
Primary
2-point Discrimination Test
The 2-point Discrimination Test determines the minimal distance at which a subject can sense the presence of two needles. The modified American Society for Surgery of the Hand guidelines were used to stratify Discriminator measurements (excellent \<6 mm; good 6-10 mm; fair 11-15 mm; poor \>15 mm. The test points were at the center of the radial or ulnar portion of the pulp. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers were considered proof of perception before proceeding to another lower value. We stopped at 4 mm as a limit of 2PD and considered this normal. The assessments were performed at a single time point at the final follow up.
Time frame: 17-25 months
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Nerve Graft | 2-point Discrimination Test | 7.5 mm | Standard Deviation 1.6 |
Secondary
Semmes-Weinstein (SW) Monofilament Test
The test points were at the center of the radial or ulnar portion of the pulp. The donor site, i.e. radial- or ulnar-dorsal aspect of the middle phalanx of the donor digit, was also evaluated.
Time frame: 17-25 months
Other Pre-specified
Pain
Pain was given subjectively by the patient using the visual analogue scale (VAS). The VAS consists of a 10 cm line that was grouped into mild (1-3 cm), moderate (4-6 cm) and severe (7-10 cm).
Time frame: 17-25 months