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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rob E, Druel T, Jalaguier T, Walch A, Gazarian A. Long-term patient-reported outcome measures of fingertip coverage with a homodigital unipedicle neurovascular island flap. J Hand Surg Eur Vol 2023; 48:920-925. [PMID: 37211794 DOI: 10.1177/17531934231172081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We report the long-term patient-reported outcomes and objective outcomes of a homodigital neurovascular island flap for distal phalangeal amputations in the fingers (with the thumb excluded) for 20 patients at a median follow-up of 4.4 years (IQR 2.2 to 12.3). We assessed the global subjective and aesthetic outcomes, range of motion, sensitivity and strength. The patient-reported median subjective global score was 7.5/10 points (IQR 7 to 9) and the aesthetic score was 8/10 points (IQR 8 to 9). Range of motion, sensitivity and strength were similar to the uninjured side. Stiffness was present in more than half of the cases; 14 patients had a hook nail deformity and seven patients reported symptomatic cold intolerance. At a long-term follow-up, the patient-reported outcome measures and objective outcomes of this flap are satisfactory and it is a safe and reliable flap.Level of evidence: IV.
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Affiliation(s)
- Edouard Rob
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
- Service de chirurgie orthopédique, Hôpital Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Thibault Druel
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Jalaguier
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
| | - Arnaud Walch
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
- Service de chirurgie orthopédique, Hôpital Pierre Zobda Quitman, Fort-de-France, Martinique, France
| | - Aram Gazarian
- Service de Chirurgie de la Main et du Membre Supérieur, Hôpital Edouard Herriot, Lyon, France
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Siriwittayakorn W, Siritattamrong W. Dorsal V - Y Advancement Flap for Lateral Finger Defect Based on Dorsal Skin Branch of Proper Digital Artery. Tech Hand Up Extrem Surg 2023; 27:165-168. [PMID: 36880327 DOI: 10.1097/bth.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Managing lateral soft tissue defects, distal to the proximal interphalangeal joint, of the finger can be challenging. The use of antegrade homodigital island flap can be limited due to the length of the defect. Using a heterodigital island flap can be precluded by an injury in the adjacent fingers. Using the locoregional flap from the hand can result in a more extensive soft tissue dissection, which can create additional donor site morbidity. We present our execution technique of the homodigital dorsal skin advancement flap. The pedicle of the flap is based on dorsal branches of the digital artery perforator; hence the proper digital artery and nerve are unharmed. The operation is limited only to the injured digit, which can reduce donor site morbidity.
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Usami S, Kawahara S, Inami K, Hirase Y. Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap. Hand (N Y) 2023; 18:1012-1018. [PMID: 35311361 PMCID: PMC10470249 DOI: 10.1177/15589447221081863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to compare the outcomes of reverse digital artery island flap (RDAIF) in primary and secondary reconstruction after failed replantation or composite graft method. METHODS This study retrospectively analyzed 42 patients that underwent RDAIF (18 primary and 24 secondary). Preoperative details (demographics, injury details, and waiting days) and postoperative outcomes (active arc of proximal interphalangeal [PIP] and distal interphalangeal (DIP) joints, extension loss of PIP, flexion arc of metacarpophalangeal joint, total active motion, flap sensation, the presence of numbness, Tinel's sign and cold intolerance) were evaluated. Quick Disabilities of the Arm, Shoulder, and Hand score (Quick-DASH) and patient satisfaction were also statistically compared between the 2 groups. RESULTS There was no significant difference in patient demographics between the 2 groups in sex, age, smoking and diabetic history, affected hand and finger, injury type and level, and flap area. The only difference was in waiting days. Similar sensory recovery and patient satisfaction were found in both groups. Range of motion in the DIP and PIP joints, extension loss of PIP, total active motion, and Quick-DASH were superior in the primary coverage group. Increasing age, subzone III injury, and secondary reconstruction were found to be the factors that adversely affected the postoperative range of motion. CONCLUSIONS Secondary reconstruction was more likely to result in joint contracture. In the event of a damaged fingertip amputation in older patients, primary flap reconstruction should be considered as the initial treatment of choice, with regard to the ultimate range of motion.
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Affiliation(s)
- Satoshi Usami
- Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopedic Hospital, Tokyo, Japan
| | - Sanshiro Kawahara
- Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopedic Hospital, Tokyo, Japan
| | - Kohei Inami
- Tokyo Hand Surgery and Sports Medicine Institute, Takatsuki Orthopedic Hospital, Tokyo, Japan
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Wang S, Yuan C, Ding W, Shen H, Gu J. Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve. Ann Plast Surg 2023; 90:559-563. [PMID: 37311311 DOI: 10.1097/sap.0000000000003591] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To illustrate the clinical outcomes of the reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defects. METHODS From December 2007 to December 2017, a total of 20 patients with finger pulp defects were treated with reverse digital proper artery island flap for innervated construction. Functional outcomes, aesthetic appearance, and complications were evaluated. Functional outcomes were assessed according to range of motion, sensory grade (S0-S4), static 2-point discrimination, Semmes-Weinstein monofilament test, and Cold Intolerance Severity Score. Aesthetic appearance was evaluated according to the Michigan Hand Outcomes Questionnaire. RESULTS All flaps survived completely without any complications, and all patients were followed up for at least 12 months. The average static 2-point discrimination, Semmes-Weinstein monofilament, and Cold Intolerance Severity Score results of the injured fingers were 6.35 mm (range, 5-8 mm), 3.64 (range, 2.83-4.17), and 19 (range, 8-24), respectively. All patients achieved recovery in sensation from S3+ to S4. The active ranges of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the affected fingers were satisfactory. Based on the Michigan Hand Outcomes Questionnaire, 11 patients were strongly satisfied, and 9 were satisfied with the appearance of the injured finger. CONCLUSIONS The reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve is an effective and reliable alternative for the reconstruction of finger pulp defect. In the recovery of sensation, this flap leads to satisfactory effects.
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Affiliation(s)
- Shuang Wang
- From the Department of Hand and Foot Surgery, Clinical Medical College of Yangzhou University, Yangzhou
| | - Chaoqun Yuan
- From the Department of Hand and Foot Surgery, Clinical Medical College of Yangzhou University, Yangzhou
| | - Wenqiang Ding
- From the Department of Hand and Foot Surgery, Clinical Medical College of Yangzhou University, Yangzhou
| | - Haobo Shen
- Department of Hand and Foot Surgery, Dalian Medical University, Dalian, China
| | - Jiaxiang Gu
- From the Department of Hand and Foot Surgery, Clinical Medical College of Yangzhou University, Yangzhou
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Castillo T, Xu J, Tiedgen A, Graham DJ, Lawson RD, Sivakumar BS. The Efficacy of Antegrade Homodigital Neurovascular Island Flaps in Distal Fingertip Reconstruction: A Systematic Literature Review. Hand (N Y) 2022:15589447221127332. [PMID: 36278422 DOI: 10.1177/15589447221127332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Antegrade homodigital neurovascular island flaps (AHIFs) are a heterogeneous group of pedicled flaps used for reconstruction of traumatic digital detipping injuries. While numerous single-center studies have documented their use, there are no large or multicentre studies validating their efficacy, applicability, and functional outcomes. We performed a systematic review of the contemporary literature to establish the safety and functional outcomes of this technique. METHODS Electronic searches were performed using PubMED, Embase, and MEDLINE from inception date to October 2020, with further studies identified from study reference lists and independent searches. Relevant studies reported on complications and functional outcomes of the AHIFs, as used for digital detipping injuries. Data were then extracted and analyzed. RESULTS Twenty-seven studies published between 1974 and 2019 yielded 744 patients. Four studies provided incomplete epidemiologic data, resulting in a total of 559 patients with 584 digital injuries. Index and middle fingers were most frequently involved. Mean final 2-point discrimination (2-PD) was 4.9 mm static and 5.1 mm dynamic, with dynamic 2-PD reported in 2 studies. Mean total active motion of the digit was 200.3°. Mean time to return to work was 6.7 weeks in 10 studies. Flap survivorship was found to be 99.6% in 23 studies. Cold intolerance was the most common complication at 18%, followed by pain and hypersensitivity. CONCLUSIONS Antegrade homodigital neurovascular island flaps provide a safe and effective method of treating distal finger amputations, yielding satisfactory functional outcomes across all ages. Further studies comparing outcomes between the AHIFs and other reconstructive modalities would be useful.
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Affiliation(s)
| | - Joshua Xu
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - David J Graham
- Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Brahman S Sivakumar
- Hornsby Ku-ring-gai Hospital, Sydney, NSW, Australia
- Royal North Shore Hospital, St Leonards, NSW, Australia
- Nepean Hospital, Kingswood, NSW, Australia
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Kim YH, Kim TH, Park JH. Comparison of Hybrid Abdominal Flap versus Homodigital Neurovascular Island Flap for Fingertip Amputation. Medicina (Kaunas) 2022; 58:1483. [PMID: 36295643 DOI: 10.3390/medicina58101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/23/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
Amputation at the level of the distal phalanx is a common hand injury and is normally treated with replantation. However, if the level of injury is distal or the vessels of the stump have been crushed by injury, replantation cannot be a viable option. The aim of this study is to evaluate the functional and aesthetic outcomes of the “hybrid abdominal flap”, which consists of a random-pattern abdominal skin flap and an autologous bone graft. A retrospective analysis was performed on fingertip amputation patients from March 2019 to April 2021. The patients were managed by either hybrid abdominal flaps (HAFs) or homodigital neurovascular island flaps (HNIFs). The functional and aesthetic outcomes were assessed three months after the operations. In this study, a total of 20 fingers were treated with either HAFs or HNIFs. There was a significant difference in the range of motion (ROM) and the scar quality between the two groups. All of the flaps survived without flap necrosis, and non-union of the bone was not observed. The patients were satisfied with the appearance and function of their fingers, including the ROM and sensory aspects. Our novel HAF is a functionally and aesthetically valid option for fingertip amputations with crushed stumps.
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Ikeguchi R, Noguchi T, Ando M, Yoshimoto K, Sakamoto D, Matsuda S. Anterolateral thigh flap for upper extremity reconstruction in older patients. Microsurgery 2022; 42:793-799. [PMID: 36196891 DOI: 10.1002/micr.30965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The anterolateral thigh (ALT) flap has been used in upper extremity reconstruction. However, there is no consensus about the age at which the flap can be used safely, which is a concern when applying ALT flaps for upper extremity reconstruction in older patients. We present the results of the use of ALT flap for upper extremity reconstruction in a series of older patients. PATIENTS AND METHODS Seventeen patients who underwent ALT flaps for soft tissue defects in the upper extremities from 2010 to 2020 were included. The patients' mean age was 63.5 (range, 26-83) years. Ten of seventeen patients were smokers. Defect locations were the dorsum of the hand in seven patients, palm in two patients, dorsum and palm in two patients, and forearm in six patients. Etiologies of the defect were traumatic in 14 patients and malignant tumor in three patients. The defect size was 8 to 25 × 5 to 11 cm. When dissecting the perforators, we preserved the surrounding small muscular and fatty tissue with the perforators and to harvest them together to prevent intima damage. Flap thinning was performed for 16 flaps to adjust the flap thickness to match defect site requirements. We used an end-to-side or interposition arterial anastomosis to regulate the blood flow. RESULTS The flap size was 9 to 28 × 5 to 13 cm. One patient had venous congestion and vein re-anastomosis was needed. All flaps survived. One patient had a methicillin-resistant Staphylococcus aureus infection and debridement and irrigation was needed. The mean follow-up period was 20 (range, 13-37) months. Fifteen patients returned their previous activities. The mean DASH score was 30.6 (range, 3-70). CONCLUSIONS Regardless of patient age or smoking status, the ALT flap was a safe and reliable surgical option for soft tissue defect reconstruction of the upper extremity.
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Affiliation(s)
- Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Takashi Noguchi
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Maki Ando
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Koichi Yoshimoto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Daichi Sakamoto
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
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Woitowich M, Yeung C, Doherty CD, Binhammer PA, Beveridge TS. Comparing Flap Advancement and Wound Coverage of Anterograde Homodigital Neurovascular Island Flap Designs: A Cadaveric Model. J Hand Surg Am 2022; 47:1012.e1-7. [PMID: 34802812 DOI: 10.1016/j.jhsa.2021.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/12/2021] [Accepted: 07/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Anterograde homodigital neurovascular island flaps are a reconstructive option for volar fingertip injuries and confer the advantage of preserving fingertip sensation after surgery. However, the amount of flap advancement and wound coverage provided by stepwise and triangular flap designs remains unknown. This study sought to investigate how incremental proximal dissection of the pedicle influences flap advancement and whether advancement and/or coverage differ between the triangular and stepwise flap designs using 22 paired cadaveric digits. METHODS Flap advancement and wound coverage were evaluated in a pairwise design such that each pair of digits received 1 stepwise flap and 1 triangular flap. After creating a standardized injury to the volar fingertip, pedicled flaps were dissected from the middle phalanx and advanced distally under consistent tension. Advancement was measured for each 5 mm of proximal mobilization of the pedicle to a maximum of 30 mm. RESULTS On average, 2.6 ± 0.2 mm of flap advancement could be achieved for every 10 mm of pedicle mobilization. With 30 mm of proximal mobilization of the pedicle, 11.8 ± 2.8 mm of advancement and 57.2% ± 16.1% of wound coverage could be expected. There were no significant differences between the flap designs. CONCLUSIONS The stepwise and triangular anterograde homodigital neurovascular island flaps offer comparable and consistent reconstructive outcomes for volar fingertip injuries. CLINICAL RELEVANCE The findings in this study suggest that the choice of flap design need not be influenced by the considerations of advancement or coverage; rather, surgeon preference or technical differences between the 2 flap designs may be of more importance.
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Yildirim T, Gunturk OB, Erol K, Toros T. Long-term outcomes of homodigital neurovascular island flap reconstruction of fingertip injuries in children. J Hand Surg Eur Vol 2022; 47:845-850. [PMID: 35786078 PMCID: PMC9459358 DOI: 10.1177/17531934221108470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated the long-term functional and cosmetic results of homodigital neurovascular island flap (NIF) used to reconstruct extensive pulp defects with bone exposure in children. Twenty-three children (mean age 4.8 years, range 1-10 years) with fingertip injuries were reconstructed with a pedicled homodigital NIF and evaluated in terms of sensation quality, cold intolerance, scar formation, nail deformity, range of motion and overall finger length at a mean follow up of 7.8 years (range 2-13). Eleven patients reported cold sensitivity in the operated fingertip, and 15 presented with hook nail deformities at the final follow-up. The total active motion of the injured finger was significantly lower than that of the uninjured side (p < 0.001). NIFs is a safe, reliable reconstructive treatment for fingertip loss in children, but commonly encountered issues in the long term include an extension lag of the interphalangeal joints, hook nail deformities and cold intolerance. Level of evidence: IV.
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Affiliation(s)
- Tugrul Yildirim
- Tugrul Yildirim, Hand Microsurgery Orthopedics
Traumatology Hospital, 1418 Sk. No.14 Kahramanlar, 35230 Izmir, Turkey.
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Tang L, Zhou X, Zou Y. Combined great toe dorsal nail-skin flap and medial plantar flap for one-stage reconstruction of degloved finger. Injury 2022; 53:2588-2594. [PMID: 35613969 DOI: 10.1016/j.injury.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Historically, the degloved finger with the total loss of nail and skin had been resurfaced with an expanded great toe wrap-around flap transfer for better outcomes. The purpose of this study aims to present our experience with a related modified design, with total preservation of a weight-bearing plantar skin. METHOD From April 2016 to September 2019, nine fingers (5 index and 4 middle fingers) in nine cases, with skin loss to the base of the proximal phalangeal or metacarpophalangeal (MCP) joint level, were reconstructed with combined great toe dorsal nail-skin flap and medial plantar artery perforator (MPAP) flap. The dorsal great toe donor was covered with a thin groin flap, and the medial plantar site was covered with a full-thickness skin graft. The cutaneous nerves were preserved within both flaps. Standardized assessment of outcome in terms of sensory, functional, and esthetic performance of the reconstructed fingers was completed. RESULTS Flap survival was achieved in all cases. The contour of the reconstructed digits was comparable with the contralateral one. The fingers were available for a mean follow-up of 28 months (ranged, 22-39 months). The mean dimension of the great toe dorsal nail-skin flap was 8.5 × 4.0 cm (ranged, 6.5 × 3.5-11.0 × 4.5 cm). The average size of the MPAP flap was 6.5 × 4.5 cm (ranged, 5.0 × 3.5-8.0 × 5.5 cm). At the last follow-up, the functional and aesthetic consequences were satisfactory, as well as the restored sensory. CONCLUSION Reconstruction of degloved fingers with the great toe dorsal nail-skin flap combined MPAP flap, preserving a plantar weight-bearing area, results in excellent contour and functional outcome. Donor-site morbidity in the foot was minimal.
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Affiliation(s)
- Lin Tang
- Department of Orthopedic Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Chunhui Avenue, Longma Tan District, Luzhou 646000, People's Republic of China
| | - Xin Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital of Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing 400037, People's Republic of China
| | - Yonggen Zou
- Department of Orthopedic Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Chunhui Avenue, Longma Tan District, Luzhou 646000, People's Republic of China.
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Gurbuz K, Dogar F, Yontar Y. Comparison of Clinical Outcomes of Heterodigital Neurovascular Island Flap, Reverse Homodigital Neurovascular Island Flap, and Cross-Finger Flap Used for Fingertip Reconstruction. Indian J Orthop 2022; 56:847-855. [PMID: 35547336 PMCID: PMC9043157 DOI: 10.1007/s43465-022-00605-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023]
Abstract
Objective The fundamentals of fingertip defect reconstructions should be mainly to restore the sensation with contour and identical pulp volume, and texture. To achieve these, various flap techniques were described in which those had their own advantages and disadvantages to restore the fingertip injuries. This study aimed to compare clinical outcomes of three different local flap procedures widely used for the reconstruction of fingertip defects: heterodigital neurovascular island (HeNI) flap, reverse homodigital neurovascular island (rHoNI) flap, and cross-finger (CF) flap. Methods Between 2014 and 2019, statistical analysis of 58 patients undergoing reconstruction of fingertip defects of 2-5 digits by HeNI flap (n = 16), rHoNI flap (n = 17), or CF flap (n = 25), was performed retrospectively. All cases were reviewed regarding age, gender, etiology of trauma, duration of follow-up, the extent of the injury with the classification system PNB, Quick Disability of Arm, Shoulder, and Hand score (Q-DASH), cold intolerance symptom severity score (CISS), static 2-point discrimination test, ROM value of phalangeal joints and time to return to work. Results The mean age of all patients was 36.9 years with a male-to-female ratio of 5.4:1 and a mean follow-up of 26.72 months. The most common cause was work-related (n = 41). The mean of DASH score, CISS score, static 2-point discrimination, time to return to work, and ROM value of DIP joint did not significantly differ between the study groups. The mean ROM values of PIP and MCP joints of patients for CF flaps applied were significantly lower than HeNI flaps. Conclusion The use of HeNI flap for fingertip reconstruction is a reliable one-stage option in terms of improved ROM of finger joints.
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Affiliation(s)
- K. Gurbuz
- Department of Orthopedics and Traumatology, Education and Research Hospital, Kayseri, Turkey ,Department of Orthopedics and Traumatology, Kayseri City Education and Training Hospital, Kocasinan, 38210 Kayseri, Turkey
| | - F. Dogar
- Department of Orthopedics and Traumatology, Education and Research Hospital, Kayseri, Turkey ,Department of Orthopedics and Traumatology, Sutcu Imam University Medical Faculty, Kahramanmaraş, Turkey
| | - Y. Yontar
- Department of Orthopedics and Traumatology, Education and Research Hospital, Kayseri, Turkey ,Department of Orthopedics and Traumatology, Kayseri City Education and Training Hospital, Kocasinan, 38210 Kayseri, Turkey ,Department of Orthopedics and Traumatology, Acıbadem Hospital, Kayseri, Turkey
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Roulet S, Delgove A, Chirez P, Chaput B, Casoli V, Pelissier P, Pinsolle V, Lepivert JC. The Homodigital Propeller Flap: A New Tool for Fingertip Reconstruction. Surgical Technique, Anatomical Study, and Clinical Relevance. Plast Reconstr Surg 2021. [PMID: 34905753 DOI: 10.1097/PRS.0000000000008723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An ideal flap for fingertip injuries should cover a significant loss of substance and avoid joint flexion to prevent later contracture and joint stiffness. In this study, the authors describe a modified homodigital island flap-the homodigital propeller flap-to better meet these requirements. METHODS An anatomical model of fingertip loss is used to analyze the advancement achieved without flexion of the finger. Twenty-four fresh-frozen fingers were dissected. Wires were inserted to maintain joints in extension. The skin paddle was similar in location to a homodigital island flap. The neurovascular bundle was dissected without exceeding the proximal interphalangeal joint and was released from the proximal half of the paddle. Then, the homodigital propeller flap was rotated 180 degrees to cover the defect. A mixture of India ink and barium sulfate was injected into the pedicle artery after the release of the proximal half of the flap from the neurovascular pedicle to assess residual flap vascularization. India ink highlights the residual subcutaneous vascularization network of the cutaneous paddle. A radiographic study of the flap was then performed to visualize the subcutaneous vascular network of the cutaneous paddle. RESULTS The homodigital propeller flap achieved an average cutaneous advancement of 18 mm (range, 15 to 22 mm) and allowed full coverage of cutaneous defects for all fingers while maintaining the proximal interphalangeal joint in strict extension. CONCLUSIONS The homodigital propeller flap is a refinement of the classic homodigital island flap. It allows efficient coverage of fingertip defects because of a large advancement without flexion of the finger reducing the risk of stiffness.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lemsanni M, Najeb Y, Chaouqui Y, Elkasseh M, Zoukal S. Fingertip injuries managed by a thenar flap: Follow-up and long-term outcomes of 32 cases. Hand Surg Rehabil 2021; 40:484-490. [PMID: 33895423 DOI: 10.1016/j.hansur.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/10/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
While various techniques are used for the reconstruction of fingertip injuries, the main goals remain the same: preserve finger length, sensation, and function. The thenar flap is a well-described technique and simple procedure in fingertip amputations. This study aimed to evaluate the long-term functional and esthetic outcomes along with patient satisfaction of thenar flaps done for fingertip defects. Thenar flaps used in 32 patients operated between January 2010 and December 2016 were analyzed retrospectively to assess sensory recovery, range of motion, cold intolerance, pain relief, appearance, patient satisfaction, and QuickDASH score. All flaps survived, without adverse events. The flap was detached after 10-14 days (mean 12.5 days). The mean follow-up was 31 months (range, 20-45 months). According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 25 patients (78%). The mean static 2-point discrimination was 6.1 mm. There were no functionally significant finger flexion contractures at the final follow-up. Complications such as pain, donor site morbidity and cold intolerance were not encountered. The thenar flap is an excellent technique for coverage of total or subtotal tissue loss of radial-side fingertips that is not accessible to local flaps. It provides good sensory function and appearance when fundamental technical principles (flap design, timing of division, and early mobilization) are respected.
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Affiliation(s)
- M Lemsanni
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco.
| | - Y Najeb
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - Y Chaouqui
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - M Elkasseh
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - S Zoukal
- Epidemiology Laboratory of the Faculty of Medicine and Pharmacy of Casablanca, Rue Tarik Ibnou Ziad, 20250 Casablanca, Morocco
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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 Orthop Traumatol Turc 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mao T, Xie R, Wang G, Xing S. Application of a modified dorsoulnar artery pedicle flap in the repair of thumb tip defects: A case report. Exp Ther Med 2020; 19:3300-3304. [PMID: 32266026 PMCID: PMC7132239 DOI: 10.3892/etm.2020.8583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/06/2020] [Indexed: 11/06/2022] Open
Abstract
Between February 2012 and March 2014 10 patients were admitted to the Affiliated Hospital of Nantong University for surgery due to a thumb tip defect. Nine of these patients were male and one was female and there were 7 cases of left thumb defects and 3 cases of right thumb defects. The surgical procedures followed were first, modification of the flap tail to an equilateral triangle, which facilitated pedicle suturing of soft tissue defects, caused mild tension and effectively reduced venous disorders, and second complete opening of the flap pedicle to the soft tissue defects at the tunnel. All patients were followed up at 6 and 12 months after surgery. Grip and pinch strength were measured 6 and 12 months after surgery. Static two-point discrimination testing of the modified flap showed minor differences from the uninjured hand. Post-surgery grip and pinch strength were restored to approximately 85% of the level of that in the uninjured hand. The modified dorsoulnar artery pedicle flap provided excellent thumb tip defect coverage and is an effective and safe technique for the restoration of grip and pinch strength to the hand after the repair of a thumb tip defect.
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Affiliation(s)
- Tian Mao
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Renguo Xie
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Guheng Wang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Shuguo Xing
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
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Appukuttan A, Ragoowansi R. The unilateral perforator V-Y flap for fingertip reconstruction-a versatile technique. JPRAS Open 2020; 23:1-7. [PMID: 32158898 PMCID: PMC7061637 DOI: 10.1016/j.jpra.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/26/2019] [Indexed: 12/05/2022] Open
Abstract
Fingertip amputations are a very common form of injury seen in the emergency departments. Various techniques have been described for the management of these injuries including simple dressings, skin grafts, homodigital, heterodigital and regional flaps and also free flaps. We present our experience with 10 cases of unilateral V-Y flaps raised on a perforator vessel and advanced in a modified fashion to cover the entire tip with a single flap. The technique is quick and easy to perform under loupe magnification, has minimal donor site morbidity and achieves good results in terms of healing, hand function, sensory recovery, appearance and patient satisfaction.
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Affiliation(s)
- A Appukuttan
- Department of Plastic Surgery, Royal London Hospital, Barts Health NHS Trust, London
| | - R Ragoowansi
- Department of Plastic Surgery, Royal London Hospital, Barts Health NHS Trust, London
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22
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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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23
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Affiliation(s)
- Jin Bo Tang
- Editor-in-Chief.,Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Abstract
We investigated the maximal advancement of the homodigital neurovascular island flap with the digit in full extension and its correlation to the digital length. In 32 adult cadaveric digits, flaps measuring 1 × 1 cm were sequentially elevated to different dissection points. Dissection of the flap to the proximal interphalangeal joint crease, palmo-digital crease, division of adjacent digital artery and the superficial arch resulted in flap advancement of 8, 12, 15 and 18 mm, respectively. The degree of advancement correlated to the length of the finger and was approximately 19% of the finger length. We conclude that dissection of a homodigital antegrade neurovascular island flap to the proximal interphalangeal joint, palmo-digital crease, after ligation of adjacent digital artery and the superficial arch allows progressively more advancement. The advancement obtained by flap dissection to the palmo-digital crease was about 19% of the finger length.
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Affiliation(s)
- Jin Xi Lim
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore.,Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alphonsus Khin Sze Chong
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Sandeep Jacob Sebastin
- Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore
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Arsalan-Werner A, Brui N, Mehling I, Schlageter M, Sauerbier M. Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap. Arch Orthop Trauma Surg 2019; 139:1171-8. [PMID: 31115665 DOI: 10.1007/s00402-019-03198-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Fingertip injuries are frequent and several surgical strategies exist to reconstruct the amputated part and restore function and appearance. Yet, long-term results are rarely published. The purpose of this study was to examine the long-term clinical outcome of neurovascular island flaps for traumatic fingertip amputation of Allen type III/IV injuries. MATERIALS AND METHODS We retrospectively analysed a cohort of patients with traumatic fingertip amputation that underwent reconstruction with a neurovascular island flap from January 2003 to December 2014. No mandatory splinting was applied after surgery. 28 participants (29 fingers) were available for follow-up at mean 8 years after reconstruction. Activities of daily living were measured with the disabilities of the arm, shoulder and hand questionnaire. Grip strength and finger motion were assessed using a Jamar dynamometer and a goniometer. Two-point discrimination and Semmes-Weinstein monofilaments were used to evaluate sensory recovery. RESULTS No intraoperative complications occurred and all flaps survived. Mean flap size was 4.7 ± 0.6 cm2. Active motion of the fingers was over 95% of the contralateral side at follow-up. Three patients showed mild extension lag of the proximal interphalangeal joint. The grip strength of the affected hand and of each of the affected fingers was over 70% of the contralateral side. In comparison to the contralateral side we did not detect any significant difference for the Semmes-Weinstein monofilament test, but two-point discrimination (5.1 ± 1.7 mm) was significantly impaired. According to the Lim classification 1 of 14 nails with hook nail deformity showed grade 3 breaking of the nail. The DASH score was 16.0. All patients returned to their original occupation and patient satisfaction with the procedure was high. CONCLUSIONS The risk for disabling flexion contracture seems to be small even without mandatory splinting. Neurovascular island flaps for fingertip amputation of Allen type III/IV injuries are a reliable tool in fingertip reconstruction in the long term.
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He B, Liu J, Pang V, Zhu L, Huang Y, Wang Z, Xu Y, Zhu Z, Wang K. Anatomical and Clinical Comparison of Small Free Flaps for Repairing Finger Skin Defects. Ann Plast Surg 2019; 83:664-9. [DOI: 10.1097/sap.0000000000001933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Usami S, Kawahara S, Inami K. Additional advancement after elevation of a neurovascular advancement flap with interposition of an artificial nerve conduit. J Plast Reconstr Aesthet Surg 2019; 72:1418-1433. [PMID: 31000359 DOI: 10.1016/j.bjps.2019.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Satoshi Usami
- Department of Hand Surgery, Tokyo Hand Surgery & Sports Medicine Institute, Takatsuki Orthopaedic Hospital, 360 Takatsukicho, Hachioji, Tokyo, Japan.
| | - Sanshiro Kawahara
- Department of Hand Surgery, Tokyo Hand Surgery & Sports Medicine Institute, Takatsuki Orthopaedic Hospital, 360 Takatsukicho, Hachioji, Tokyo, Japan
| | - Kohei Inami
- Department of Hand Surgery, Tokyo Hand Surgery & Sports Medicine Institute, Takatsuki Orthopaedic Hospital, 360 Takatsukicho, Hachioji, Tokyo, Japan
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Abstract
The authors' experience demonstrates that wide-awake flap surgery in the hand is safe. The authors used this approach in 4 commonly used flaps in the hand in 27 patients: the extended Segmuller flap, the homo-digital reverse digital artery flap, the dorsal metacarpal artery perforator flap, and the Atasoy advancement flap. Wide-awake flap surgery works very well and safely achieved excellent anesthetic and vasoconstrictive effects in the authors' cases. The authors found that vasoconstriction caused by epinephrine mainly affects the capillaries and does not affect digital arteries and their major branches in the hand.
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Tapan M, İğde M, Yıldırım AR, Yaşar B, Ergani HM, Duru Ç. Reverse Thenar Perforator Flap for Large Palmar and Digital Defects. J Hand Surg Am 2018; 43:956.e1-956.e6. [PMID: 29754756 DOI: 10.1016/j.jhsa.2018.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
Reconstruction of large, full-thickness palmar and digital defects is challenging. The glabrous skin of the palm provides excellent color and texture match for palmar hand and digital defects. The reverse thenar perforator flap, which was previously infrequently used, provides a method for primary closure of large glabrous palmar skin defects. Because of the origin of the source vessels, the reverse thenar perforator flap is a good choice for larger radial-sided palmar and finger defects. This flap provides good aesthetic results for both the donor and the recipient.
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Affiliation(s)
- Mehmet Tapan
- Department of Plastic Reconstructive and Aesthetic Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Murat İğde
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ali Rıza Yıldırım
- Department of Plastic Reconstructive and Aesthetic Surgery, Igdir Public Hospital, Igdir, Turkey
| | - Burak Yaşar
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Hasan Murat Ergani
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Çağdaş Duru
- Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Santos TPSD, Oliveira MTD, Angelini LC. Retrospective study to evaluate the treatment of digital pulp lesions using a homodigital flap. Rev Bras Ortop 2018; 53:200-207. [PMID: 29911087 PMCID: PMC6001392 DOI: 10.1016/j.rboe.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/23/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the homodigital flap surgical procedure, as well as the function of the finger, pain, sensation, esthetics, and patient satisfaction. Method Retrospective analysis of records and questionnaires of patients who underwent this surgical technique between the months of May 2013 and October 2016. Eight were included in the study, with an average follow-up period of 23 months. Patients with digital pulp lesions of the thumbs and those who did not perform rehabilitation were excluded. All underwent the two-point discrimination test, the Semmes–Weinstein test, and range of motion evaluation. The age varied from 22 to 59 years (average of 32.9), six (75%) being male patients. Results Three patients (37.5%) had involvement of the right hand and five of the left (62.5%). Regarding the etiology, seven suffered injury and one a chemical burn. The average distance obtained from the two-point discrimination test was 7.3 mm. All patients who underwent the Semmes–Weinstein test obtained response to the purple filament. The average sum of the range of motion of the affected digit was 98.9%. The flap area was on average 294.4 mm2. The return to work averaged seven weeks. A positive Tinel sign was found in the donating area and two reported intolerance to cold. Partial or total necrosis of the flap was not observed. Conclusion The homodigital flap technique presented satisfactory esthetics and functional results regarding feasibility, sensation, and digital mobility in pulp lesions.
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Affiliation(s)
- Tarsila Pagnan Silva Dos Santos
- Hospital do Servidor Público Municipal (HSPM), Departamento de Ortopedia e Traumatologia, Centro de Cirurgia e Microcirurgia da Mão, São Paulo, SP, Brazil
| | - Marcelo Tavares de Oliveira
- Hospital do Servidor Público Municipal (HSPM), Departamento de Ortopedia e Traumatologia, Centro de Cirurgia e Microcirurgia da Mão, São Paulo, SP, Brazil
| | - Luiz Carlos Angelini
- Hospital do Servidor Público Municipal (HSPM), Departamento de Ortopedia e Traumatologia, Centro de Cirurgia e Microcirurgia da Mão, São Paulo, SP, Brazil
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31
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Chong CW, Lin CH, Lin YT, Hsu CC, Chen SH. Refining the cross-finger flap: Considerations of flap insetting, aesthetics and donor site morbidity. J Plast Reconstr Aesthet Surg 2018; 71:566-572. [DOI: 10.1016/j.bjps.2017.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 11/24/2022]
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32
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Santos TPSD, Oliveira MTD, Angelini LC. Estudo retrospectivo para avaliação do tratamento de lesões da polpa digital com retalho homodigital. Rev Bras Ortop 2018; 53:200-7. [DOI: 10.1016/j.rbo.2017.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bourne DA, Sivak W, Spiess AM. Current trends in local flaps of the hand. Current Orthopaedic Practice 2018; 29:127-134. [DOI: 10.1097/bco.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feng SM, Sun QQ, Cheng J, Wang AG. A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit. Orthop Surg 2017; 9:372-379. [PMID: 29178311 DOI: 10.1111/os.12350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/31/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Providing soft tissue coverage for finger neurocutaneous defects presents aesthetic and sensory challenges. A common source for reconstruction of soft tissue defects of the fingers is the same finger. However, when the donor areas are damaged by concomitant injuries, this option is not available. The present study aims to reconstruct finger neurocutaneous defects using a sensory reverse dorsal digital artery flap from the neighboring digit and to evaluate the efficacy of this technique. METHODS The study included 16 patients, with an average age of 34.9 years (range, 20-53 years) at the time of surgery, from May 2010 to June 2013. The sensory reverse dorsal digital artery flap was used in all 16 patients, who had a combination of soft tissue and digital nerve defects. The mean size of the soft tissue defects was 3.1 cm × 2.0 cm, and the mean flap size was 3.3 cm × 2.2 cm. The length of the nerve defects ranged from 1.3 to 2.5 cm (mean, 2.0 cm), which were reconstructed with dorsal branches of the proper digital nerve transfer. The active motion of the fingers (injured and donor) and the flap sensibility (static two-point discrimination) were measured. The appearance and functional recovery of the injured finger and the donor site were assessed using the Michigan Hand Outcomes Questionnaire. RESULTS All flaps survived completely. No complications were reported, and no further flap debulking procedure was required. At the mean follow-up period of 24 months (range, 18-30 months), the mean static two-point discrimination was 6.5 mm (range, 5-10 mm) of the reconstructed area; the mean ranges of motions of the injured finger and the opposite finger at the proximal interphalangeal and distal interphalangeal joints were 102.2° and 103.5°, and 70.3° and 76.5°, respectively. The average ranges of motions of the metacarpophalangeal and proximal interphalangeal joints of the donor fingers were 90° and 103.4°, respectively. Based on the Michigan Hand Outcomes Questionnaire, 10 patients were strongly satisfied and 6 were satisfied with the functional recovery of the injured finger; however, 13 patients were strongly satisfied and 3 were satisfied with the appearance of the injured finger. CONCLUSION The sensory reverse dorsal digital artery flap from the neighboring digit, based on the dorsal branch of the digital artery, is an effective and additional option for finger neurocutaneous defect reconstruction when use of the local and regional flaps is not feasible.
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Affiliation(s)
- Shi-Ming Feng
- Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China.,Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China
| | - Qing-Qing Sun
- Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China.,Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China
| | - Jian Cheng
- Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China
| | - Ai-Guo Wang
- Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China.,Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, 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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Abstract
UNLABELLED The bilateral V-Y flap concept for fingertip reconstruction was first desribed by Kutler. This method has limitations, such as flap size and advancement, therefore larger flap modifications are described to increase the advancement capacity of the flaps. We described a small direct-flow homodigital island flap method, called the 'super Kutler flap', for recontruction of finger pulp defects. In addition, neurorrhaphy was performed between the cut ends of the digital nerves to prevent neuroma formation. This method was used in 10 fingers in patients who had undergone pulp tissue reconstruction of fingertip defects from May 2008 to October 2011. The mean defect size was 2.2 × 1.7 cm. The mean static two-point discrimination was 3.5 mm and the mean Semmes-Weinstein monofilament test of the flaps was 2.83 g. The super Kutler flap provides an altenative option for reconstruction of fingertip defects. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- E Arpaci
- 1 The Department of Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Konya, Turkey
| | - R E Unlu
- 2 The Department of Plastic and Reconstructive Surgery, Ankara Numune Education and Research Hospital, Aknara, Turkey
| | - S Altun
- 3 The Department of Plastic and Reconstructive Surgery, Firat University Faculty of Medicine, Elazig, Turkey
| | - N M Ertas
- 4 The Department of Plastic and Reconstructive Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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Gong X, Cui J, Jiang Z, Lu L, Li X. Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis. ANZ J Surg 2017; 88:E127-E131. [PMID: 28481465 DOI: 10.1111/ans.13977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 02/19/2017] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few clinical retrospective studies have reported the risk factors of pedicled flap necrosis in hand soft tissue reconstruction. The aim of this study was to identify non-technical risk factors associated with pedicled flap perioperative necrosis in hand soft tissue reconstruction via a multivariate logistic regression analysis. METHODS For patients with hand soft tissue reconstruction, we carefully reviewed hospital records and identified 163 patients who met the inclusion criteria. The characteristics of these patients, flap transfer procedures and postoperative complications were recorded. Eleven predictors were identified. The correlations between pedicled flap necrosis and risk factors were analysed using a logistic regression model. RESULTS Of 163 skin flaps, 125 flaps survived completely without any complications. The pedicled flap necrosis rate in hands was 11.04%, which included partial flap necrosis (7.36%) and total flap necrosis (3.68%). Soft tissue defects in fingers were noted in 68.10% of all cases. The logistic regression analysis indicated that the soft tissue defect site (P = 0.046, odds ratio (OR) = 0.079, confidence interval (CI) (0.006, 0.959)), flap size (P = 0.020, OR = 1.024, CI (1.004, 1.045)) and postoperative wound infection (P < 0.001, OR = 17.407, CI (3.821, 79.303)) were statistically significant risk factors for pedicled flap necrosis of the hand. CONCLUSION Soft tissue defect site, flap size and postoperative wound infection were risk factors associated with pedicled flap necrosis in hand soft tissue defect reconstruction.
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Affiliation(s)
- Xu Gong
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jianli Cui
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, China
| | - Ziping Jiang
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, China
| | - Laijin Lu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, China
| | - Xiucun Li
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun, China
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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 2017; 44:403-14. [DOI: 10.1016/j.cps.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Usami S, Okazaki M. Fingertip reconstruction with a posterior interosseous artery perforator flap: A minimally invasive procedure for donor and recipient sites. J Plast Reconstr Aesthet Surg 2017; 70:166-172. [DOI: 10.1016/j.bjps.2016.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/10/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
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Usami S, Okazaki M, Nitta T, Uemura N, Homma T, Akita K. Histological investigation of common insensate flaps obtained from the hand and forearm regions for use in fingertip reconstruction. J Plast Surg Hand Surg 2016; 51:182-186. [PMID: 27687797 DOI: 10.1080/2000656x.2016.1213733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Many skin flaps have been described for fingertip reconstruction; however, they have not been compared histologically. The aim of this study is to compare the histological features of common insensate flaps that are used for fingertip reconstruction. METHOD Skin from fingertips and common flap donor sites on the hand and forearm of cadavers were harvested. This study investigated four histological characteristics, namely thickness of the epidermis and dermis; the ratio of collagen to elastic fibres (C/E ratio) in subdermal tissues, and distribution densities of Merkel cells and Meissner's corpuscles. It then compared the values obtained to determine which flap donor site best matched the fingertip. RESULTS Epidermal thickness of the reverse digital artery island flap, thenar flap, and hypothenar flap was similar to that of fingertip tissue; dermal thickness of the hypothenar flap was similar to that of fingertip tissue. The C/E ratio of the reverse digital artery island flap was similar to that of fingertip tissue. Merkel cells were abundant in the reverse digital artery island flap, but Meissner's corpuscles were few in each of the flaps compared with fingertip tissue. CONCLUSION The flap donor site with histological properties most similar to fingertip tissue was the palmar lateral aspect at the finger base, representative of the reverse digital artery island flap with respect to epidermal thickness, C/E ratio, and presence of Merkel cells. The thenar and hypothenar flaps also showed similar properties.
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Affiliation(s)
- Satoshi Usami
- a Department of Plastic and Reconstructive Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Mutsumi Okazaki
- a Department of Plastic and Reconstructive Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tomohisa Nitta
- a Department of Plastic and Reconstructive Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Noriko Uemura
- a Department of Plastic and Reconstructive Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Tsutomu Homma
- a Department of Plastic and Reconstructive Surgery , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | - Keiichi Akita
- b Department of Clinical Anatomy , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
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Wei P, Chen W, Mei J, Ding M, Yu Y, Xi S, Zhou R, Tang M. Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator. Plast Reconstr Surg Glob Open 2016; 4:e730. [PMID: 27482478 DOI: 10.1097/GOX.0000000000000732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/12/2016] [Indexed: 11/28/2022]
Abstract
Background: The purposes of this article are to introduce and assess the results of a long-term follow-up of using anterograde pedicle flap based on the dorsal branches of proper digital neurovascular bundles from the dorsum of the middle phalanx for the fingertip defect. Methods: Between February 2011 and December 2012, 31 patients underwent reconstruction of fingertip defects using a homodigital flap based on the dorsal perforator in the middle phalanx. The defect size ranged from 1.3 cm × 1.5 cm to 2.4 cm × 3.0 cm. During surgery, the flap was designed on the dorsal middle phalangeal region. The pedicle was a neurovascular bundle consisting of an artery, vein, and sensory nerve; the rotation of pedicle was <90 degrees. Results: The clinical results were satisfactory after 3 to 9 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The sensory recovery was excellent, 2-point discrimination was 4.96 ± 1.47 mm, and the recovery of range of motion of the interphalangeal joints was very good. Conclusions: The anterograde island flap based on the dorsal branches of proper digital neurovascular bundles is an ideal aesthetic reconstruction method for fingertip defect. A 90-degree rotated island pedicle flap was very versatile, easy to design, and had good survival. This technique is simple with less damage to the donor site, without sacrificing the branch of the digital artery and nerve. The reliable source of blood supply and satisfactory recovery of sensation can be achieved without affecting the interphalangeal joint activity.
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Abstract
UNLABELLED This retrospective study was designed to investigate the prevalence, characteristics and natural history of cold intolerance after the use of the reverse digital artery flap. A total of 123 patients were treated between 2010 and 2013. After excluding patients who were lost to follow-up, 87 patients were studied. The mean follow-up time was 34 months (range 14-61). Cold intolerance occurred in 60% (52) of patients after the reverse digital artery flap procedure. The condition improved in only 15% (8) of the patients. Significant differences were observed in the age and the specific digit involved between the groups with and without cold intolerance. There was a lower incidence in younger patients, and the ring finger group showed a lower incidence than in other fingers. Furthermore, the Cold Intolerance Symptom Severity score was positively correlated with the temperature at which cold intolerance was triggered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Y C Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Q Z Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - J Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Z W Qian
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - J Kong
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Y P Gong
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
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Ozcanli H, Cavit A. Innervated Digital Artery Perforator Flap: A Versatile Technique for Fingertip Reconstruction. J Hand Surg Am 2015; 40:2352-7. [PMID: 26527595 DOI: 10.1016/j.jhsa.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To demonstrate the advanced use of innervated digital artery perforator (IDAP) flaps for fingertip reconstruction. METHODS From August 2011 to May 2014, 65 fingers (59 patients) underwent fingertip or finger stump reconstruction using IDAP flaps. Sixty-one fingers from 55 patients who were followed up for more than 6 months were included in this study. The objective outcomes of patient evaluations consisted of the results of static 2-point discrimination tests, Semmes Weinstein monofilament tests, and extension loss tests. The subjective patient outcome evaluations consisted of the results of hypersensitivity and cold intolerance tests and patient satisfaction. RESULTS All flaps survived completely, and no patients required early secondary interventions. The mean follow-up period was 18 months (range, 6-36 months). The static 2-point discrimination in the flaps ranged from 2 to 6 mm (mean, 3.5 mm) compared with a range of 2 to 3 mm (mean, 2.5 mm) in the contralateral hands. The Semmes Weinstein monofilament test results ranged from 0.07 to 1.4 g compared with 0.04 to 0.4 g for the contralateral hand. One patient exhibited mild extension loss in the reconstructed finger, 4 patients experienced mild cold intolerance, and 2 patients exhibited mild hypersensitivity. CONCLUSIONS The IDAP flaps are sensitive, reliable, and versatile and should be considered for reconstructing acute fingertip defects. The use of IDAP flaps for revisions of previously reconstructed defects is also possible. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Chen QZ, Sun YC, Chen J, Kong J, Gong YP, Mao T. Comparative study of functional and aesthetically outcomes of reverse digital artery and reverse dorsal homodigital island flaps for fingertip repair. J Hand Surg Eur Vol 2015; 40:935-43. [PMID: 25862526 DOI: 10.1177/1753193415579300] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/18/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED This retrospective study was designed to compare functional and cosmetic outcomes of the reverse digital artery island flap and reverse dorsal homodigital island flap in fingertip repair. A total of 23 patients were followed for 24 to 30 months. The reverse digital artery island flap was used in 12 patients, and reverse dorsal homodigital island flap in another 11 patients. Flap sensibility was assessed using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Patient satisfaction, active motion of the finger joints, complications and cold intolerance were evaluated. The static 2-point discrimination and Michigan Hand Outcomes Questionnaire (appearance) of the fingers treated with a reverse digital artery flap were significantly better than those with a reverse dorsal homodigital flap. The static 2-point discrimination of the skin-grafted donor sides after dorsal homodigital flap were poorer than that in the contralateral finger. No significant differences were found between the two flaps for pressure or touch sensibility, active ranges of digital motion, complications and cold intolerance. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Q Z Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Y C Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - J Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - J Kong
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - Y P Gong
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
| | - T Mao
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Jiangsu, China
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Abstract
In this review, an international group of senior hand surgeons was asked to provide their currently used methods, views, and advice on thumb and fingertip repair. The basic requirements and methods of thumb and fingertip repair are first outlined, followed by descriptions of the methods favored by individual units or surgeons. More recent innovative methods and modifications are described and challenging topics are discussed. This review ends by illustrating and discussing a few exploratory treatments that hold promise of greatly changing future perspectives of this common clinical problem.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China.
| | - David Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Verona Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37126, Italy
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Felix Stang
- Plastic Surgery, Hand Surgery, and Burns Unit, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany
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