PMC5731612_01
The ventral part of the finger and X-ray image of the index finger at the time of injury. (A) Soft tissue defect was observed on the ventral part of the index finger that was pinned for fixing the open fracture of the middle phalanx. (B) X-ray image showed the fracture of the middle phalanx of the index finger.
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He had the following injuries: an open fracture of the middle phalanx of the index finger, extensor tendon rupture, and a high-grade crush injury (Figure 1).
Intraoperative and postoperative views of the wound site of the index finger. (A) Photograph showed the intraoperative views of the wound after arterialized venous flaps transplant. (B) On postoperative day 5, the congestion of the flap on the wound was observed.
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Because the unfavorable engraftment of the skin graft was expected, an arterialized venous flap from the right forearm was transplanted (Figure 2). Although the perfusion of the flap was favorable, congestion and edema in the flap were observed on postoperative day 5 (Figure 2B).
Application procedure of PICO dressing. (A) Before the application of PICO dressing, the sufficient amount of no-sting barrier film (SECURA) was applied to the around the wound. (B) Gel sealer was applied to the middle part of the finger. (C) Photograph showed the dorsum of the hand after PICO dressing application. The aspiration port with drain tube was placed on the dorsum of the hand. (D) Photograph showed the palmar side of the hand after PICO dressing application.
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First, the sufficient amount of no-sting barrier film (SECURA; Smith & Nephew) was applied for increasing the adhesion between the skin and the dressing (Figure 3A). A gel seal (Renasys Adhesive Gel Patch; Smith & Nephew) was applied around the dressing (Figure 3B). Finally, a drape was applied (Figure 3C and D).
The wound at 4 months after surgery. (A) The ventral part of the finger. At 4 months postoperatively, although mild atrophy was found in the arterialized venous flap, the morphology was favorable. (B) The maximum flexion position of the finger. At 4 months postoperatively, although a little weakness was observed in distal interphalangeal joint movement with a percent total active motion of 61%, there was no inconvenience in daily life.
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At 4 months postoperatively, although mild atrophy that was one of common complications with arterialized venous flap was noted, the morphology of the finger was favorable (Figure 4A). Although a little weakness in DIP joint movement with a percent total active motion of 61% was found, no limitations in the extension of each joint was noted, resulting in no inconvenience in daily life (Figure 4B).