Evaluation of the results of salvage surgical treatment of distal phalanx injuries and substantiation of the algorithm of finger salvage treatment

Abstract

Introduction The rates of hand injuries in the structure of total of injuries range from 30 to 50 % in recent decades. The improvement of approaches to the choice of optimal options for treatment of injuries of the distal phalanges of fingers that ensure the preservation of anatomical integrity and function of fingers remains relevant. The purpose of the work was a comparative analysis of the clinical efficacy of various methods for surgical treatment of trauma to the distal phalanx of fingers. Methods Forty-seven patients (18 men and 29 women, mean age 34.2 ± 13.3 years) with injuries to the distal phalanges of the fingers were examined and treated. The patients were divided into 2 groups. Group 1 (comparison) was 25 patients. Conventional approaches to the formation of finger stumps were used by shortening the bone part of the phalanx, forming two opposite flaps and applying several interrupted sutures; group 2 (main group) were 22 patients treated according to the surgical tactics developed by us. The proposed tactics of reconstructive plasty of the defects in the nail phalanges of three joint fingers involves the formation of a stump of the nail phalanx with a visual effect of elongation of the phalanx due to local or cross-plasty with dermo-fascial flaps. Comparison of treatment results in the groups of patients was performed 1, 3, 6, 12 months after reconstruction operations. Results It was established that the use of the developed surgical treatment of the injury to the distal phalanx of the fingers results in less severity (compared to the use of standard methods) of pain on days 10-21 after surgery (by 44.8-54.3 %), lower levels of the Quick DASH indicators after 3-12 months, decrease in Vancouver scoring of skin scar severity changes after 6-12 months, higher patient satisfaction with the functional result of treatment. Based on the results obtained, a diagnostic and treatment algorithm for providing medical care to hand injuries has been proposed. Discussion The results of the study indicate the effectiveness of the developed method of plastic surgery of fingertip defects of nail phalanges in the three joint fingers by moving the palmar-lateral and dorsal-lateral blood-supplied flaps from the fingers of the same name and neighboring fingers without shortening the bone stumps of the nail phalanges while achieving an esthetic result by visual lengthening of the fingertip phalanx. Based on the results obtained, a diagnostic and treatment algorithm for providing medical care to patients with finger injuries has been proposed.

Keywords

• finger injury
• nail phalanx
• end defect
• skin flap plastic surgery
• pain syndrome
• skin scar