Ms. Meng, a 55-year-old woman, encountered an accident while using a grinding machine, resulting in the complete loss of the finger pulps on all five fingers of her right hand, putting her at risk of amputation. Dr. Ju Yu Tang, Director and Professor of Orthopedics at Xiangya Hospital of Central South University, led a team that utilized cutting-edge international techniques in special pedicled skin flap transplantation. They harvested five skin flaps from the patient's left arm and successfully transplanted them onto the pulp of the five fingers of her right hand in a single operation, thus preserving her right hand.
Upon investigation, it was found that the combination of a radial collateral branch-flap and a three-leaf pedicled skin flap from the dorsal metacarpal artery was successfully used to repair the deficiency of the five finger pulps in a single operation, marking a global first. The patient is recovering well postoperatively and will be discharged at a later date.
Intraoperative Flap Design. Image provided by Xiangya Hospital.
Ms. Meng presented with skin defects on the fingertips of her first to fifth digits, open fractures and bone defects at the interphalangeal joints, deficits in joint capsules and flexor tendons, and intrinsic nerve and vascular deficits in the second to fifth digits. Additionally, there was an open fracture with bone loss at the metacarpophalangeal joint of the index finger, and partial bone loss at the distal phalanx of the thumb.
In response, a tailored reconstruction surgical plan was devised by the hand microsurgery team. The surgery, lasting over 11 hours, concluded successfully. Dr. Tang Juyu remarked that traditionally, such complex injuries might have resulted in amputation or, in cases where digit preservation was pursued, abdominal pedicle flap repair followed by staged debulking, secondary finger division, subsequent finger separation, and finally, tendon grafting for functional reconstruction. However, amputation would have resulted in significant loss of hand function, requiring over five surgeries for limb preservation, with poor outcomes both aesthetically and functionally, and incurring substantial time and financial costs.
The surgery performed at Xiangya Hospital utilized a specialized technique developed by Professor Tang Juyu's team, known as the Tang II P-Ch flap for reconstruction of the thumb distal phalanx bone defect and thumb and index finger pulp defect wounds, and the Tang I P flap for precise repair of the middle, ring, and little finger pulp defects. This innovative approach significantly reduces the number of surgeries required, thereby shortening the treatment duration, alleviating patient suffering, and lowering medical expenses, while also yielding superior aesthetic and functional outcomes compared to traditional methods.
Professor Tang Juyu is credited with introducing the concepts of "minimally invasive" and "aesthetic" approaches to flap reconstruction surgery, as well as pioneering the naming system for flaps based on the "first-level source artery + flap" principle and the concept of "special form flaps." He has developed a comprehensive theoretical framework for special form flaps. In 2022, the "Expert Consensus on the Naming of Special Form Flaps and Derived Surgical Procedures" recognized his contributions by establishing the "Tang Classification" for special form flap derived surgical procedures, acknowledging his significant breakthroughs and original contributions to microsurgical flap reconstruction.
