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Chakraborty SS, Sahu RK, Acharya S, Goel AD, Midya M, Kotu S. Donor Finger Morbidity in Cross-Finger Flap: A Systematic Review and Meta-Analysis. Indian J Plast Surg 2023. [DOI: 10.1055/s-0042-1760092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Abstract
Background The morbidity of donor finger in a cross-finger flap has not received as much importance as the outcomes of the flap itself. The sensory, functional, and aesthetic morbidity of donor fingers, reported by various authors, are often contradictory to each other. In this study, objective parameters for the sensory recovery, stiffness, cold intolerance, cosmetic outcome, and other complications in the donor fingers, reported in the previous studies, are systematically evaluated.
Methods This systematic review is reported using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol and was registered with the International prospective register of systematic reviews (PROSPERO registration no. CRD42020213721). Literature search was done using “cross-finger,” “heterodigital,” “donor finger,” and “transdigital” words. Data regarding demography, patients' number and age, follow-up duration and outcomes of donor finger, including 2-point discrimination, range of motion (ROM), cold intolerance, questionnaires, etc. were extracted from included studies. Meta-analysis was performed using MetaXL and risk of bias was evaluated using Cochrane risk of bias tool.
Results Out of the total 16 included studies, 279 patients were objectively evaluated for donor finger morbidity. Middle finger was most frequently used as donor. Static two-point discrimination seemed to be impaired in donor finger in comparison to contralateral finger. Meta-analysis of ROM suggested that statistically there is no significant difference in ROM of interphalangeal joints in donor and control fingers (pooled weighted mean difference: −12.10; 95% confidence interval: −28.59, 4.39; I2 = 81%, n = 6 studies). One-third of donor fingers had cold intolerance.
Conclusion There is no significant effect on ROM of donor finger. However, the impairment that seems to be in sensory recovery and aesthetic outcomes needs to be further evaluated objectively.
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Affiliation(s)
- Sourabh Shankar Chakraborty
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Kalyani, Nadia, West Bengal, India
| | - Ranjit Kumar Sahu
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudeshna Acharya
- Department of Trauma & Emergency, Burdwan Medical College, Bardhaman
| | - Akhil Dhanesh Goel
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manojit Midya
- Plastic & Reconstructive Surgery Department, Government Medical College, Kota, Rajasthan, India
| | - Suresh Kotu
- Department of Burns and Plastic Surgery, GSL Medical College, Rajahmundry, Andhra Pradesh, India
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Chakraborty SS, Dixit PK, Kala PC, Sahu RK, Katrolia D, K S. A Prospective Trial Comparing Outcomes at 11 Months of a Standard Cross-Finger Flap versus a Laterally Based Thenar Flap for Fingertip Reconstruction. J Hand Surg Asian Pac Vol 2022; 27:49-56. [PMID: 35135424 DOI: 10.1142/s2424835522500187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The standard cross-finger flap (CFF) and laterally based thenar flap (LTF) are the time-tested modalities of fingertip reconstruction. We were unable to find any studies that have compared these two flaps for fingertip reconstruction. The aim of this study is compare the outcomes of these two flaps at 11 months after fingertip reconstruction. Methods: This is a prospective study of 40 patients with fingertip amputation who underwent reconstruction with either a standard CFF or an LTF. Data with regards to the patient, the injury, treatment and complications were recorded. Patients were followed up weekly for the first 6 weeks and at 3, 6, 9 and 12 months thereafter. Outcome measures assessed at final follow-up included passive range of motion, two-point discrimination, cold intolerance, patient aesthetic satisfaction with the flap, assessment of donor scar and psychosocial benefit. Results: Fingertip reconstruction was done with 23 CFFs and 17 thenar flaps. Partial necrosis was noted in three thenar flaps. The mean follow-up period was 11 months. The sensory recovery and aesthetic satisfaction with the flap were greater in thenar flap group. There were no differences between the two flaps in the other outcome measures. Conclusions: Sensory recovery and aesthetic outcomes were better in thenar flaps compared to a CFF. However, thenar flap were associated with a greater incidence of partial flap loss. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
| | - Pawan Kumar Dixit
- Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prakash Chandra Kala
- Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ranjit Kumar Sahu
- Department of Plastic Surgery, All India Institute of Medical Sciences, Sijua, Patrapada, Bhubaneswar, Odisha, India
| | - Deepti Katrolia
- Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suresh K
- Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tang JB, Landín L, Cavadas PC, Thione A, Chen J, Pons G, Masià J. Unique Techniques or Approaches in Microvascular and Microlymphatic Surgery. Clin Plast Surg 2021; 47:649-661. [PMID: 32892807 DOI: 10.1016/j.cps.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Cosmetics of the narrow neck of transferred second toes can be improved with insertion of a flap. Lymphedema of the breast after cancer treatment can be diagnosed with several currently available imaging techniques and treated surgically with lymphaticovenous anastomosis.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
| | - Luis Landín
- Plastic & Reconstructive Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
| | - Pedro C Cavadas
- Reconstructive Surgery Unit, Clinica Cavadas, Paseo Facultades 1, bajo 8, Valencia 46021, Spain
| | - Alessandro Thione
- Reconstructive Surgery Unit, Clinica Cavadas, Paseo Facultades 1, bajo 8, Valencia 46021, Spain
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, Barcelona 08026, Spain
| | - Jaume Masià
- Department of Plastic Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, Barcelona 08026, Spain
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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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Current trends in local flaps of the hand. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Qattan MM. Time of return back to work and complications following cross-finger flaps in industrial workers: Comparison between immediate post operative mobilization versus immobilization until flap division. Int J Surg Case Rep 2017; 42:70-74. [PMID: 29223881 PMCID: PMC5726747 DOI: 10.1016/j.ijscr.2017.11.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022] Open
Abstract
Previous authors have immobilized the hand following cross finger flaps. We studied two groups of injured industrial workers. Group I (n = 12) had immediate postoperative mobilization. Group II (n = 12) had immobilization till the time of flap division. Complications were similar but Group I returned back to work earlier.
Introduction Previous authors have immobilized the injured hand or digits following cross finger flaps. Patients and methods About 3 years ago, the author adopted a protocol of immediate postoperative active and passive mobilization (without a splint) following cross finger flap surgery in industrial workers. The current study is a retrospective audit comparing postoperative complications and time of return back to work following cross-finger flaps in two groups of injured industrial workers: Group I (n = 12) had immediate postoperative mobilization; and Group II (n = 12) had immobilization till the time of flap division. Results The complication rate was similar in both groups. However, patients in Group I returned to work earlier than those in group II and the difference was statistically significant. Conclusion Immediate postoperative mobilization following cross-finger flaps in industrial workers does not increase the risk of complications and has the advantage of early return to work.
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Affiliation(s)
- M M Al-Qattan
- From the Division of Plastic and Hand Surgery at King Saud University, PO Box 18097, Riyadh 11415, Saudi Arabia.
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Wang ZT, Zheng YM, Zhu L, Hao LW, Zhang YB, Chen C, Xia LF, Liu LF. Exploring New Frontiers of Microsurgery. Clin Plast Surg 2017; 44:211-231. [DOI: 10.1016/j.cps.2016.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Paulino ZC, Tao S. Functional thenar eminence myocutaneous flap for reconstruction of thumb volar defect. Chin J Traumatol 2017; 18:175-7. [PMID: 26643246 DOI: 10.1016/j.cjtee.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This case report describes the use of a Functional Thenar Eminence myocutaneous flap for reconstruction of volar defect of distal right thumb of a 25-year-old male who sustained a twisting injury while working. Part of bone and tendon were exposed and the tip of the distal phalanx was crushed, with bony defect.
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Affiliation(s)
- Zefanias Carlos Paulino
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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Kloczko E, Nikkhah D, Yildirimer L. Scaffolds for hand tissue engineering: the importance of surface topography. J Hand Surg Eur Vol 2015; 40:973-85. [PMID: 25770899 DOI: 10.1177/1753193415571308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/14/2015] [Indexed: 02/03/2023]
Abstract
Tissue engineering is believed to have great potential for the reconstruction of the hand after trauma, congenital absence and tumours. Due to the presence of multiple distinct tissue types, which together function in a precisely orchestrated fashion, the hand counts among the most complex structures to regenerate. As yet the achievements have been limited. More recently, the focus has shifted towards scaffolds, which provide a three-dimensional framework to mimic the natural extracellular environment for specific cell types. In particular their surface structures (or topographies) have become a key research focus to enhance tissue-specific cell attachment and growth into fully functioning units. This article reviews the current understanding in hand tissue engineering before focusing on the potential for scaffold topographical features on micro- and nanometre scales to achieve better functional regeneration of individual and composite tissues.
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Affiliation(s)
- E Kloczko
- UCL School of Life and Medical Sciences, University College London, London, UK
| | - D Nikkhah
- The Queen Victoria Hospital, East Grinstead, UK
| | - L Yildirimer
- Centre for Nanotechnology & Regenerative Medicine, UCL Division of Surgery & Interventional Science, University College London, London, UK Department of Plastic and Reconstructive Surgery, Royal Free Hospital Hampstead NHS Trust, London, UK
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