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Nguyen R, Delvaque JG, Mas V, Ilharreborde B, Jehanno P. Fingertip amputations in children: Atasoy flap's indications and limitations. Orthop Traumatol Surg Res 2024:103954. [PMID: 39038515 DOI: 10.1016/j.otsr.2024.103954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 05/31/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION The Atasoy flap is considered simple and reliable for covering distal digital defects in adults. Various studies in children have shown more contrasting results, particularly in terms of aesthetics and function. The aim of this study is to evaluate the long-term results of this flap specifically in children, in order to determine its limitations and indications. HYPOTHESIS The Atasoy flap is reliable and reproducible for coverage of distal digital substance loss up to zone 2 in children. MATERIALS AND METHODS Fifty-six children who benefited from an Atasoy flap operated on between January 2017 and January 2020 were included. Lesion area, operative technique, postoperative complications (infection, healing difficulties, necrosis), and ultimately nail appearance, cold intolerance or finger pain, finger eviction, extension defect, and final parental satisfaction were analyzed. RESULTS Forty-nine children were evaluated with a mean follow-up of 18 months (min = 3 months, max = 38 months, SD = 11.3 months). Eighteen children had a hook nail, resulting in 6 of them having their finger excluded. The majority of hook nails were found in zone III and in proximal zone II lesions (12 cases). Eighty-nine percent of children with distal suture fixation to the nail bed (8 children) had this complication. Cold intolerance was present in 9 children. There were no cases of extension failure or early post-operative complications. Final parent satisfaction was 9.1/10 (min = 5, max = 10, SD = 1.3). CONCLUSION The Atasoy flap in children appears reliable for covering loss of distal digital substance. The main complication is the occurrence of hook nails. Compliance with its indications (transverse substance loss not exceeding the proximal third of zone II) and a precise surgical technique (distal needle fixation without suturing to the nail bed, deep flap lift, non-closure of the donor site) help limit this risk. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Raphaël Nguyen
- Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015 Paris, France.
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Díaz LC, Vergara-Amador E, Camacho Castro F. V-Y Flap Over Moberg's Flap to Cover the Thumb's Fingertip Injury: Technique and Cases. Tech Hand Up Extrem Surg 2023; 27:151-156. [PMID: 37594139 DOI: 10.1097/bth.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
The Moberg flap has been used to achieve coverage of amputations of the thumb's fingertip. However, it has been associated with flexion contractures of the interphalangeal (IP) joint of the thumb. A modification of the surgical technique is presented, adding a distal V-Y flap to allow greater advancement, and avoiding IP joint contractures. The proposed surgical technique is presented, and a case series of patients treated with this modification is introduced. A total of 5 patients underwent this surgical technique. All the flaps healed without complications. No patient presented stiffness or flexion contracture of the thumb´s IP joint. There were no cases of neuropathic pain and the 2-point discrimination over the flap was 6.8 mm on average. In conclusion, the proposed variation to the Moberg's flap allows adequate coverage of injuries to the thumb's fingertip with a low rate of complications, adequate sensitivity of the reconstructed digit and avoiding flexion contractures of the IP joint.
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Affiliation(s)
- Luis Carlos Díaz
- Orthopedics and Traumatology, Hand Surgery, Clínica Asotrauma, Ibague
| | - Enrique Vergara-Amador
- School of Medicine, Orthopedics and Traumatology, Hand Surgery, Universidad Nacional de Colombia, Bogotá
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Chakraborty SS, Kala PC, Sahu RK, Dixit PK, Katrolia D, Kotu S. Fingertip Amputation Reconstruction with VY Advancement Flap: Literature Review and Comparative Analysis of Atasoy and Kutler Flaps. World J Plast Surg 2021; 10:8-17. [PMID: 34912662 DOI: 10.29252/wjps.10.3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/12/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Many different flaps had been described to cover exposed bone in fingertip amputations and injuries. The variants of VY advancement flap, by far the simplest, had proven to render good functional and aesthetic outcome. We aimed to revisit and compare the various VY advancement flaps in fingertip reconstruction. METHODS PubMed [MEDLINE] database was searched for VY advancement flap in fingertip reconstruction. Demographic and outcome data were extracted from relevant studies and comparative analysis was made. Patients with fingertip amputations undergoing reconstruction by either Kutler of Atasoy flaps in our institute, were assessed for sensory recovery, cold intolerance, joint's range of motion, and aesthetic outcomes and results were analysed. RESULTS Among the 744 articles, 32 citations went full text review and were included, while data of 13 articles were tabulated. Weighted mean of 2PD in Kutler and Atasoy estimated to be 6 and 7.5 mm respectively. Hook nail deformity was in 29% and 35%, pain was present in 71% and 30% patients, in Kutler and Atasoy flaps respectively. Forty fingertips with Allen type II/III were reconstructed. Sensory outcomes of Atasoy flap and Kutler flaps were better than the previous study results. Four patients had cold intolerance. All patients achieved satisfactory aesthetic outcome. CONCLUSION Over time, VY advancement flap have been successfully used for reconstruction of Allen type II-IV fingertip amputations, as suggested by the good sensory, functional and aesthetic outcomes.
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Affiliation(s)
| | - Prakash Chandra Kala
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Ranjit Kumar Sahu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pawan Kumar Dixit
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Deepti Katrolia
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Suresh Kotu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, India
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Feng SM, Zhao JJ, Migliorini F, Maffulli N, Xu W. First dorsal metacarpal artery flap with dorsal digital nerve with or without dorsal branch of the proper digital nerve produces comparable short-term sensory outcomes. J Orthop Surg Res 2021; 16:685. [PMID: 34794478 PMCID: PMC8600886 DOI: 10.1186/s13018-021-02838-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022] Open
Abstract
Background The first dorsal metacarpal artery flap, including dorsal digital nerves with or without dorsal branches of the proper digital nerves, can be used to reconstruct thumb pulp defects with good results. However, it is still unclear whether there are differences in the sensory outcomes between preserving or not preserving the dorsal branches of the proper digital nerves. Methods This retrospective cohort study included 137 thumb pulp defect patients who underwent first dorsal metacarpal artery flap reconstruction procedure from October 2015 to June 2019. Patients were divided into two groups according to whether the dorsal branches of the proper digital nerves were preserved. In the non-preservation group (n = 80), the dorsal digital nerves were included in the flap for sensory reconstruction. In the preservation group (n = 57), the dorsal digital nerves and the dorsal branches of the proper digital nerves of the index finger were included in the flap. The stump of the proper digital nerves in the defect was coaptated to the donor nerves of the flap using the end-to-end fashion. At the last follow-up, static two-point discrimination, Semmes–Weinstein monofilament scores, pain, cold intolerance of the reconstructed finger, and patient satisfaction in both groups were compared. Results All patients were followed up for at least 17 months. No significant differences were found regarding pain of thumb pulp, static two-point discrimination, Semmes–Weinstein monofilament score, cold intolerance in the injured finger, and patient satisfaction. The non-preservation group presented slightly shorter operative times (p < 0.05). Conclusion There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. Level of evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Shi-Ming Feng
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China.,Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Jia-Ju Zhao
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, No. 1055, the Sanxiang Road, Suzhou, 215004, Jiangsu, People's Republic of China.
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Arik A, Cevik K, Özcanyüz B. Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries. J Hand Surg Eur Vol 2021; 46:865-872. [PMID: 34018872 DOI: 10.1177/17531934211015858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the use of obliquely oriented V-Y advancement pulp flaps to reconstruct 17 consecutive, lateral oblique fingertip traumatic defects over a 2-year period. All flaps survived completely with no bone protuberance, prominent scar or neuroma evident at an average follow-up of 11 months (range 7 to 19). Although there was no incidence of severe hook nail deformities, there were two patients who had residual mild hook nails, two with pulp/nail asymmetries and one with an ingrown nail. The mean static two-point discrimination was 3.9 mm (range 2 to 8) and the mean Semmes-Weinstein monofilament test score 3.6 g (range 2.44 to 4.56). No correlation was found between the flap obliquity angle and sensory test results. We recommend the obliquely oriented V-Y pulp flap as a reliable reconstructive option for the cover of lateral oblique fingertip defects.Level of evidence: IV.
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Affiliation(s)
- Atilla Arik
- Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey
| | - Kadir Cevik
- Department of Orthopaedics and Traumatology, Mersin University Hospital, Mersin, Turkey
| | - Burç Özcanyüz
- Department of Orthopaedics and Traumatology, Adana City Training and Research Hospital, Adana, Turkey
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Estoppey D, Pomares G, Jager T. Long-term outcome of a "short" anterograde homodigital neurovascular island flap with a simple or double V-Y plasty. Orthop Traumatol Surg Res 2021; 107:102981. [PMID: 34102334 DOI: 10.1016/j.otsr.2021.102981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/11/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterograde homodigital neurovascular island flaps are very useful for reconstructing proximal fingertip amputations with exposed bone but have the disadvantage of bringing about proximal interphalangeal joint (PIPJ) stiffness. The addition of a single or double V-Y plasty increases mobility without having to extend the dissection beyond the PIPJ. The purpose of this study was to examine the long-term functional outcome of patients who received a "short" anterograde homodigital neurovascular island flap with a single or double V-Y plasty. Our primary hypothesis was that this flap did not induce PIPJ stiffness and our secondary hypothesis was that it preserved good fingertip sensation. MATERIALS AND METHODS This was a retrospective study of patients operated between August 2017 and February 2019. The inclusion criteria were the following: a fingertip amputation caused by either a crush or laceration injury with exposed bone, treated during the acute phase of the injury or for secondary necrosis (attempted replantation or subtotal amputation) and classified as type II oblique palmar, type III or type IV amputations according to the Allen classification system. The assessment criteria were: joint mobility, sensory evaluation with the two-point discrimination and Semmes-Weinstein monofilament tests, time to healing, postoperative complications, postoperative splinting, duration of work stoppage, perioperative smoking, cold intolerance, touch hypersensitivity, nail deformity and excluded finger. RESULTS Nine patients (mean age 53.9 years [32-67]) were operated, of which eight long fingers and one thumb. One procedure was complicated by skin flap necrosis. At the mean follow-up of 22.4 months [16-31], the mean mobility for the metacarpophalangeal joint (MCPJ), proximal interphalangeal joint and distal interphalangeal joint (DIPJ) were 92-0-0°, 97.8-1.5-0° and 60.3-6.8-0°, respectively. In comparison to the contralateral side, a significant difference was only detected in the DIPJs. The mean two-point discrimination in the proximal portion of the flaps were 7.1mm on the ulnar side (p<0.05) and 7.6mm on the radial side (p<0.01), while in the distal portion they were 7.3mm (p<0.01) and 7.8mm (p<0.01). The Semmes-Weinstein monofilament test also detected significantly reduced sensation. CONCLUSION The combination of a "short" anterograde homodigital neurovascular island flap with a single or double V-Y plasty seems to avoid PIPJ stiffening while preserving good fingertip sensation. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Daniel Estoppey
- Institut européen de la main, Hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg, Luxembourg.
| | - Germain Pomares
- Institut européen de la main, Hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg, Luxembourg
| | - Thomas Jager
- Institut européen de la main, Hôpital Kirchberg, 9, rue Edward-Steichen, 2540 Luxembourg, Luxembourg
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Fingertip Amputation Reconstruction with VY Advancement Flap: Literature Review and Comparative Analysis of Atasoy and Kutler Flaps. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.3.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lan X, Huang Y, Guo L, Lin J. Treatment of fingertip defect with reversed digital artery island flap through superficial vein anastomosis. ANZ J Surg 2021; 91:E584-E588. [PMID: 33634939 DOI: 10.1111/ans.16698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/09/2020] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study prospectively explored the clinical effect of a reversed digital artery island flap (RDAIF) in repairing fingertip defects and the impact of the anastomosis of superficial veins in the recipient area on the incidence of venous crisis. METHODS A total of 92 patients with fingertip defects who underwent RDAIF from February 2016 to February 2018 were enrolled in this prospective, randomized, controlled trial. Of these, 44 patients underwent superficial vein anastomosis. The perioperative data, clinical efficacy and complications of the two groups were compared by the chi-squared test and binary logistic regression analysis. RESULTS The average follow-up time was 7.0 ± 2.9 months. The incidence of venous congestion was significantly correlated with flap size, surgical time and anastomosis of superficial veins (Wald = 6.512, 9.353 and 11.662; P = 0.011, 0.002 and 0.001, respectively). The fingertips of the two groups of patients were well repaired, wear resistant and stable in holding, and the two-point discrimination was 5-8 mm. CONCLUSION RDAIF is a safe and effective method for the treatment of fingertip defects, especially in patients who require maintenance of function or contour of the fingertip. Anastomosis of the superficial veins and reduction of the flap area and surgical time can significantly reduce the incidence of venous congestion.
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Affiliation(s)
- Xianfeng Lan
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yuming Huang
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Liang Guo
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Jingui Lin
- Department of Hand Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
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Optimization of the homodigital antegrade island flap for fingertip reconstruction: New dissection sequence based on cadaver study findings. Orthop Traumatol Surg Res 2020; 106:335-339. [PMID: 32199786 DOI: 10.1016/j.otsr.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/11/2019] [Accepted: 01/05/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The homodigital antegrade island flap pedicled on the proper palmar digital artery is very useful for covering fingertip defects. However, it has its drawbacks, such as the risk of stiffness due to retractile scars and the need for extensive dissection with long-lasting dysesthesia in some cases. In clinical studies, expanding the skin paddle with V-shaped incisions increases the flap's advancement. We wanted to know whether making these V incisions for paddle expansion would make dissection on the volar side of the proximal interphalangeal joint unnecessary. METHODS A cadaver study was performed with four fresh-frozen upper limbs. Sequential dissection was carried out on 32 flaps, allowing us to compare the advancement obtained and the area of the flap's paddle between each step. RESULTS Crossing the palmar crease of the proximal interphalangeal joint provides only 2mm advancement of the homodigital antegrade flap. Adding one or two V-shaped incisions in the flap with limited dissection provides additional advancement of 4.1mm (p<0.05) and 6.9mm (p<0.05) relative to the standard flap. DISCUSSION Our study shows the possibility of increasing the homodigital antegrade flap's advancement - without having to extend the dissection proximally to the PIP joint - by making V-shaped incisions in the paddle. Based on our findings, we have proposed a new flap dissection sequence.
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Karjalainen T, Jokihaara J. A Review and Meta-analysis of Adverse Events Related to Local Flap Reconstruction for Digital Soft Tissue Defects. Hand Clin 2020; 36:107-121. [PMID: 31757343 DOI: 10.1016/j.hcl.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We reviewed the current literature to estimate incidence rates for adverse events with pedicled flaps in the hand. We identified 241 different studies reporting adverse events for 6693 flaps. The average incidence rate was 5.4% and total or partial loss of flap constituted 65% of all reported complications. Flaps with reverse or perforator-based flow may be more prone to vascular complications compared with flaps with antegrade flow or skin pedicle. The incidence rates were acceptable in all flaps (1%-10%) and thus the flap can be chosen primarily based on considerations other than risk of adverse events.
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Affiliation(s)
- Teemu Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Malvern, Australia; Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 16, Jyväskylä 40620, Finland.
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland; Faculty of Medicine and Health Technology, Tampere University, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland
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Hu D, Chen P, Zhang F, Lin H, Zheng H, Zhou X. The V-Y advancement flap based on the dorsal carpal perforators for dorsal metacarpal reconstruction: Anatomical and clinical study. Clin Anat 2020; 33:1144-1151. [PMID: 31894596 DOI: 10.1002/ca.23554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/20/2019] [Accepted: 12/28/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Soft-tissue defects on the dorsal hand accompanied by exposed bone and tendon remain a challenge for plastic surgeons. The purpose of this study was to observe the morphological characteristics of the dorsal carpal perforators in the wrist and to design a V-Y advancement flap based on the dorsal carpal perforators. MATERIALS AND METHODS Thirty cadaveric hand specimens were dissected to observe the origin, course, branches, and anastomoses of the dorsal carpal perforators, and a V-Y advancement flap was designed based on these perforators. Clinically, nine cases of dorsal hand defects were reconstructed with this flap. RESULTS The dorsal carpal vascular network was formed by vascular anastomoses along the dorsal carpal branch of the radial artery, dorsal carpal branch of the anterior interosseous artery, ascending branch of the dorsal carpal perforator from the deep palmar arch, direct branch of the radial artery, dorsal carpal branch of the ulnar artery, posterior interosseous artery, and deep palmar branch of the ulnar artery; this network could be divided into a deep vascular network and superficial vascular network according to the anatomical plane. Among the perforators, the third and fourth perforators that pierce out bilaterally from the tendon of the extensor digitorium had a consistent occurrence rate (100%) with an outer diameter of 0.7 ± 0.3 mm and 0.6 ± 0.2 mm, respectively, and thus could be chosen as the vascular pedicle. In clinical applications, all flaps survived completely with excellent color and texture, a satisfactory appearance, and normal movement of the wrist joint. CONCLUSIONS A V-Y advancement flap based on the dorsal carpal perforators can become a useful choice for the repair of dorsal metacarpal defects caused by trauma or dorsal metacarpal arterial flaps.
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Affiliation(s)
- Deqing Hu
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peng Chen
- Department of Orthopedics, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fei Zhang
- Department of Comparative Medicine, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of PLA), Fuzhou, China
| | - Haiqing Lin
- Department of Comparative Medicine, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of PLA), Fuzhou, China
| | - Heping Zheng
- Department of Comparative Medicine, Fuzong Clinical Medical College of Fujian Medical University (The 900th Hospital of PLA), Fuzhou, China
| | - Xiao Zhou
- Department of Hand Surgery, Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
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Haehnel O, Plancq MC, Deroussen F, Salon A, Gouron R, Klein C. Long-Term Outcomes of Atasoy Flap in Children With Distal Finger Trauma. J Hand Surg Am 2019; 44:1097.e1-1097.e6. [PMID: 31005461 DOI: 10.1016/j.jhsa.2019.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/11/2018] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Distal finger trauma is one of the most frequent emergencies in children and has the potential for functional and cosmetic damage to the hand. The Atasoy flap (AF) is a vascularized, subcutaneous pedicle V-Y advancement flap used to cover a loss of distal finger substance. Our hypothesis was that the AF is a safe, reliable flap that results in few complications and gives satisfactory functional and cosmetic results in children. METHODS We retrospectively assessed children with distal finger trauma and AF pulp reconstruction in our pediatric orthopedic department between 2008 and 2017. The lesion zone was classified, and we also evaluated necrosis, infection, the shape of the pulp, pulp sensitivity (Weber test), hyponychial scarring, and the presence of a hook nail deformity. Lastly, we compared patients who developed a hook nail with those who did not. RESULTS Thirty children were included (mean age at trauma, 6.4 years [range, 1.3-15.7 years]). In 21 cases, the finger damage was located in Ishikawa subzone II. No cases of necrosis or infection were reported. Epicritical tactile sensitivity was good in 20 patients (67%). A hook nail deformity was observed in 15 children (50%) and hyponychial scarring in 22 patients (73%). The pulp had a normal shape in 13 children (43%). The hook nail group displayed more hyponychial scarring, greater nail dystrophy, and lower pulp sensitivity. CONCLUSIONS The AF yielded contrasting results. High reliability, good coverage, and minimal donor-site morbidity were compromised by suboptimal tip length/shape, nail appearance, and sensitivity. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ouri Haehnel
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Marie-Christine Plancq
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Francois Deroussen
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Arielle Salon
- Université Paris Descartes, Sorbonne Paris Cité, Department of Pediatric Orthopedics, Hôpital Necker Enfants Malades, Paris, France
| | - Richard Gouron
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France
| | - Céline Klein
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, Amiens, France.
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Expanded Utilization of the Digital Atasoy Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e2049. [PMID: 30656123 PMCID: PMC6326594 DOI: 10.1097/gox.0000000000002049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/12/2018] [Indexed: 11/25/2022]
Abstract
Background The Atasoy, or Kleinert flap, is well-known to hand surgeons. This triangular volar V-Y flap is frequently used for reconstruction of fingertip amputations with exposed bone. It is indicated in transverse amputations or in dorsal oblique amputations, providing replacement of an area of skin and subcutaneous tissues with sensibility. Originally, this flap was not recommended for use in volar oblique amputations (greater volar tissue loss). With the described modifications and recommendations, modest volar oblique amputations can be closed in a single stage, obviating a 2-stage procedure. Methods With the described technical modifications, modest volar oblique amputations can be closed. An injury that previously may have required a 2-stage procedure can be closed in a single stage. Results The elevation of the flap was originally described as a dissection at the volar periosteum from a distal approach. This distal dissection is no longer recommended, as it does not create advancement. Beasley indicated the need for division of the vertical fibrous septa proximally for flap mobilization. This technique description emphasizes the importance of this division of the fibrous septa rather than stretching. Careful treatment of the remaining bone is stressed. Coverage of the nail bed is not recommended.
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