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Zhang YF, Xing CM, Chen QZ, Gong YP. Reverse dorsolateral proximal phalangeal island flap: Long-term results. HAND SURGERY & REHABILITATION 2024; 43:101680. [PMID: 38431045 DOI: 10.1016/j.hansur.2024.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This study aims to present long-term follow-up results of the reverse dorsolateral proximal phalangeal island flap designed for reconstruction of large fingertip and pulp defects. METHODS We examined 18 patients who underwent reverse dorsolateral proximal phalangeal island flap surgery to address ≥2.5 cm fingertip and pulp defects. Mean follow-up was 84.4 months. Sensitivity assessments were conducted using the Semmes-Weinstein monofilament and 2-point discrimination tests. Additionally, we evaluated finger joint active range of motion, complications and cold intolerance. RESULTS Mild venous congestion was observed in 5 flaps. Significant differences were observed in 2-point discrimination and Semmes-Weinstein monofilament tests between the injured and contralateral sides, specifically in the flaps, the dorsal side of the middle phalanx, and the donor site. The flap's mean static 2-point discrimination was 8.3 mm. Restricted distal interphalangeal joint extension was observed in 2 cases. Total active motion with the flap was good or excellent in the injured fingers, but with a significant difference between injured and contralateral fingers. Additionally, 42% of the injured fingers exhibited hook nail deformity, and 2 patients reported cold intolerance. Despite these issues, most patients has high scores for the appearance and satisfaction aspects of the Michigan Hand Outcomes Questionnaire. CONCLUSION In moderate or larger fingertip defects, the reverse dorsolateral proximal phalangeal island flap serves as an alternative for reconstructing both fingertip and pulp issues. However, this option involves sacrificing some sensation in the dorsum of the middle phalangeal finger and the donor area. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Yang Fan Zhang
- Department of Orthopedic Surgery, Jingmen Central Hospital, Jingmen, Hubei, 448000, PR China; Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Jiangsu, 226001, PR China
| | | | - Qing Zhong Chen
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Jiangsu, 226001, PR China.
| | - Yan Pei Gong
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Jiangsu, 226001, PR China
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Uzel K, Çelik V, Abacı YH, Eskandari MM. Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations. J Orthop Sci 2023:S0949-2658(23)00251-8. [PMID: 37839979 DOI: 10.1016/j.jos.2023.08.012] [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: 06/16/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Antegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. METHODS Twenty patients with a mean age of 37 (18-63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. RESULTS All flaps survived completely at the end of follow-up (mean, 36 months; range 11-64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2-8) and Semmes-Weinstein monofilament test score was 3.48 ± 0.6 (2.44-4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). CONCLUSIONS Since AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kadir Uzel
- University of Medipol, School of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
| | | | | | - Metin Manouchehr Eskandari
- University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology, Division of Hand Surgery, Mersin, Turkey.
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Ma J, Ding Y, Xu L, Zou H, Wu J, Shen L, Xing C, Liu Y, Zhou Z, Zhan J. Repair of fingertip defect with reverse digital artery island flap and repair of donor site with digital dorsal advancement flap. Front Surg 2023; 10:1127356. [PMID: 37123544 PMCID: PMC10130516 DOI: 10.3389/fsurg.2023.1127356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Objective The reverse digital artery island flap (RDAF) is widely used in repairing fingertip skin defects based on its good appearance and practicability. However, the donor area of the flap needs skin grafting, which can lead to complications. This retrospective study explored the clinical application of digital dorsal advance flap (DDAF) in repairing the donor site of the reverse digital artery island flap. Method From June 2019 to February 2022, 17 patients with a soft tissue defect of the finger had been restored with the reverse digital artery island flap, and at the same time, the donor area was repaired with digital dorsal advance flap (DDAF). The sensitivity, the active range of motion (ROM) and patient satisfaction were assessed after the operation. Results All flaps survived completely without skin grafting with only one linear scar. The sensory and motor functions of all patients recovered well. Assessment based on the Michigan Hand Outcomes Questionnaire (MHQ) showed satisfactory functional recovery for all patients. Conclusions Reconstruction using RDAF combined with DDAF represents an effective alternative for repairing fingertip skin defects.
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Affiliation(s)
- Junwei Ma
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
- Department of Orthopedic Surgery, First Affiliated Hospital, China Medical University, Shenyang, China
- Correspondence: Junwei Ma Jie Zhan
| | - Yunqi Ding
- Department of Gynaecology, Shenyang Women's and Children's Hospital, Shenyang, China
| | - Lina Xu
- Operating Room, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Haibo Zou
- Department of Anesthesiology, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Jinsheng Wu
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Lin Shen
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Changtai Xing
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Yue Liu
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Zehui Zhou
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
| | - Jie Zhan
- Hand Surgery Department, Central Hospital Affiliated to Shenyang Medical Collage, Shenyang, China
- Correspondence: Junwei Ma Jie Zhan
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Xiong X, Xu M, Shuai M, Guo CJ, Wang C, He ZL, Li H. Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction. Ann Plast Surg 2022; 88:395-400. [PMID: 34334672 DOI: 10.1097/sap.0000000000002967] [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: 11/25/2022]
Abstract
OBJECTIVE This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction. PATIENTS AND METHODS We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated. RESULTS The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications. CONCLUSIONS The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.
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Affiliation(s)
- Xu Xiong
- From the Department of Orthopedic Surgery, the 908th Hospital of the Chinese People's Liberation Army Joint Logistics Support Forces, Nanchang, PR China
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Bian R, Liu J, Yang Y. The incidence and severity of the cold intolerance after reverse homodigital dorsoradial flap for coverage of thumb tissue defect. J Orthop Sci 2022; 28:573-576. [PMID: 35307253 DOI: 10.1016/j.jos.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reverse homodigital dorsoradial flap (RHDF) has been an optional treatment for thumb soft tissue defects. The current study aims to investigate the incidence and severity of cold intolerance after the use of the RHDF for thumb soft tissue reconstruction. METHODS 49 patients with thumb soft-tissue defects treated with RHDF from 2010 to 2018 were included with the mean follow-up time of 36 (range, 14-61) months. The assessment of sensory recovery in the flap, the Cold Intolerance Symptom Severity (CISS) questionnaire, symptoms triggering temperature grade, and natural history of the symptoms were included in the final follow-up. RESULTS 35 out of 49 patients (71.4%) reported cold intolerance. The mean CISS score of 35 cases was 28 (range 3-72) points. The mean age of the intolerance group was significantly older than that of the non-cold intolerance group. The incidence of cold intolerance in the dorsum was significantly lower than in the pulp and tip. Significantly positive correlations were presented between CISS scores and temperature grades of symptoms triggered. Seven patients were with partial recovery while 6 patients were with complete recovery from negative symptoms. 22 patients reported no change in terms of the symptoms. CONCLUSIONS Cold intolerance is a common complication after the RHDF for thumb tissue reconstruction, especially in the elderly population. Cold intolerance following RHDF warrants more attention for surgeons to describe the patient expect after the procedure.
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Affiliation(s)
- Rongpeng Bian
- Department of Orthopedic Surgery, Yancheng NO.1 People's Hospital, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Jiajia Liu
- Department of Trauma Center, Affiliated Hospital of Nantong University, Nantong, China
| | - Yang Yang
- Department of Trauma Center, Affiliated Hospital of Nantong University, Nantong, China.
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Means KR, Saunders RJ. Understanding and Measuring Long-Term Outcomes of Fingertip and Nail Bed Injuries and Treatments. Hand Clin 2021; 37:125-153. [PMID: 33198913 DOI: 10.1016/j.hcl.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
There are many outcome measures to choose from when caring for or studying fingertip and nail bed trauma and treatments. This article outlines general outcome measures principles as well as guidelines on choosing, implementing, and interpreting specific tools for these injuries. It also presents recent results from the literature for many of these measures, which can help learners, educators, and researchers by providing a clinical knowledge base and aiding study design.
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Affiliation(s)
- Kenneth R Means
- The Curtis National Hand Center @ MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Rebecca J Saunders
- The Curtis National Hand Center @ MedStar Union Memorial Hospital, Baltimore, MD, USA
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Tang JB, Wang ZT, Chen J, Wong J. A Global View of Digital Replantation and Revascularization. Clin Plast Surg 2020; 47:437-459. [PMID: 32892794 DOI: 10.1016/j.cps.2020.06.002] [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
Survival rates of digital replantation vary in different regions and countries, and Asian surgeons see more challenging cases and have developed some unique methods. Replantation of multiple digits in one or both hands can follow a structure-by-structure method or a digit-by-digit method. For replanting all 10 digits, 3 or 4 teams should be organized. Flow-through flaps, often venous flaps, can be taken from the distal forearm or lower extremity to repair defects of soft tissues and arteries. A pedicled digital artery flap from the adjacent digit can also repair tissue defects and supply blood to the replanted digit.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Zeng Tao Wang
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jason Wong
- Department of Plastic and Reconstructive Surgery, The University of Manchester, Manchester, UK
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Ayhan E, Çevik K, Çelik V, Eskandari MM. Patient satisfaction after innervated digital artery perforator flap for fingertip injuries. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:269-275. [PMID: 32544063 DOI: 10.5152/j.aott.2020.03.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to analyze the relationship between patient satisfaction and outcome measures. METHODS A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in this retrospective study. Patients' injured finger and defect type were recorded. At the last follow-up, the static two-point discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We performed correlation and logistic regression analyses between patient satisfaction and outcome measures. RESULTS The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from 2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended. CONCLUSION IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Egemen Ayhan
- Division of Hand Surgery, Department of Orthopaedics and Traumatology, University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Kadir Çevik
- Department of Orthopaedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey
| | - Velat Çelik
- Clinic of Hand Surgery, İskenderun State Hospital, Hatay, Turkey
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Zhao G, Mi J, Rui Y, Pan X, Yao Q, Qiu Y. Correlation of volumetric flow rate and skin blood flow with cold intolerance in digital replantation. Medicine (Baltimore) 2017; 96:e9477. [PMID: 29390590 PMCID: PMC5758292 DOI: 10.1097/md.0000000000009477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Cold intolerance is a common complication of digital replantation. The exact etiology is unclear, but it is considered to be multifactorial, including nonsurgical characteristics, vascular, and neurologic conditions. Blood flow may play a significant role in cold intolerance. This study was designed to evaluate the correlation of digital blood flow, including volumetric flow rate (VFR) and skin blood flow (SkBF), with cold intolerance in replanted fingers.A retrospective study was conducted among patients who underwent digital replantation between 2010 and 2013. Patients were selected into study cohort based on the inclusion criteria. Surgical data was collected on each patient, including age, sex, injury mechanism, amputation level, ischemia time, number of arteries repaired, and whether or not vascular crisis occurred. Patients were included as study cohort with both nerves repaired and without chronic disease. Cold intolerance was defined as a Cold Intolerance Symptom Severity (CISS) score over 30. The arterial flow velocity and caliber were measured by Color Doppler Ultrasound and the digital VFR was calculated. The SkBF was measured by Laser Speckle Imager. Both VFR and SkBF were calculated as a percentage of the contralateral fingers. Comparative study of surgical data and blood flow was performed between the patient with and without cold intolerance. Correlation between VFR and SkBF was also analyzed.A total of 93 patients met inclusion criteria for the study. Approximately, 42 patients were identified as having cold intolerance. Fingers that survived vascular crisis had a higher incidence of cold intolerance with a lower VFR and SkBF. The VFR was higher in 2-artery replantation, but the SkBF and incidence of cold intolerance did not differ significantly. No differences were found in age, sex, injury mechanism, amputation level, or ischemia time. Furthermore, no correlation was found between VFR and SkBF.Cold intolerance of digital replantation is associated with decreased SkBF and VFR in the replanted fingers, which survived vascular crisis. Further work will be focused on how vascular crisis cause the decreasing of SkBF and VFR and the increasing chance of cold intolerance.
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Affiliation(s)
- Gang Zhao
- Department of Medicine, Soochow University, Suzhou
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Jingyi Mi
- Department of Medicine, Soochow University, Suzhou
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Yongjun Rui
- Department of Medicine, Soochow University, Suzhou
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Xiaoyun Pan
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Qun Yao
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
| | - Yang Qiu
- Department of Hand Surgery, Wuxi Ninth People's Hospital, Wuxi, Jiangsu, China
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Abstract
The authors' strategy for soft-tissue coverage of the hand is presented. The concept of replacing like with like and reconstruction with similar adjacent tissue enhances functional and aesthetic outcomes. In this viewpoint, the pedicle perforator flap is an ideal flap. A decision-making algorithm to select an ideal flap for a particular hand defect is challenging, requiring experiential consideration of functional outcome, appearance, donor-site morbidity, and patient satisfaction. To assist surgeons in determining the most appropriate flap with more evidence, studies are necessary to compare the outcomes of each flap by evaluating hand function, aesthetics, donor site morbidity, and patient satisfaction.
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Tang JB, Wang ZT, Chen J, Wong J. A Global View of Digital Replantation and Revascularization. Clin Plast Surg 2017; 44:189-209. [DOI: 10.1016/j.cps.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee SH, Cheon SJ, Kim YJ. Clinical application of a free radial artery superficial palmar branch flap for soft-tissue reconstruction of digital injuries. J Hand Surg Eur Vol 2017; 42:151-156. [PMID: 27609218 DOI: 10.1177/1753193416666396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Unsuccessful reconstruction of injured fingers can lead to poor outcomes. The aim of this article was to investigate the clinical application of the radial artery superficial palmar branch flap for soft-tissue reconstruction of the finger. We treated 125 patients with various finger injuries who underwent free radial artery superficial palmar branch flap reconstruction between October 2010 and March 2015. There were 46 distal finger injuries, 25 distal finger amputation following failed replantation and 54 palmar digital injuries with tendon, bone or joint exposure requiring soft-tissue reconstruction. Of the 125 cases, 114 flap reconstructions were considered successful. We believe that a free radial artery superficial palmar branch flap transfer is credible and useful for reconstructing various finger injuries. LEVEL OF EVIDENCE III.
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Affiliation(s)
- S H Lee
- 1 Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan, Republic of Korea
| | - S J Cheon
- 1 Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan, Republic of Korea
| | - Y J Kim
- 2 Centum Institute for Hand and Microsurgery, West Busan Centum Hospital, Pusan, Republic of Korea
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