Reverse digital artery cross-finger flap for reconstruction of failed finger replantation

PURPOSE

This study aimed to describe the reverse digital artery cross-finger flap (RDAC flap) in the treatment of failed finger replantation.

METHODS

This study retrospectively reviewed the records of patients who underwent modified RDAC flap reconstructions for failed finger replantation and assessed their outcomes. Of the patients who underwent soft tissue reconstructions for finger injuries between March 2011 and February 2015, we enrolled 11 patients in whom RDAC flap reconstruction procedures were performed to treat the failed replantations.

RESULTS

The flaps survived in all cases, with a mean static, two-point discrimination value of 5.3 mm (range, 4-7 mm) in the healed flaps. The sizes of the flaps ranged from 2 × 1 cm² to 2.3 × 1.5 cm².

CONCLUSION

The RDAC flap was introduced by Lai et al., and it is a mixed form with the advantages of both cross-finger flap and heterodigital island flap. Our results suggest that it could provide reliable coverage of the sensate soft tissue of fingers with failed replantation.

Modified Heterodigital Neurovascular Island Flap for Sensory Reconstruction of Pulp or Volar Soft Tissue Defect of Digits

PURPOSE

We report the efficacy of a modified heterodigital neurovascular island flap innervated by the dorsal branch of the proper digital nerve and the proper digital nerve, for repairing either pulp or volar defects in the fingers.

METHOD

We repaired 14 digits of 14 patients who had a complex defect involving soft tissue and digital nerve in the pulp or volar surface of the digit using the modified heterodigital neurovascular island flap. Cases were divided into 2 groups: a pulp defect group including 5 thumbs and 1 little finger; and a volar defect group with a digital nerve defect, involving one thumb, 3 index and 3 middle fingers, and one ring finger. At the recipient site, nerve stumps of the PDNs in the pulp defect group were coapted with the proximal ends of the dorsal branch of the PDN and the proper digital nerve in the flap. The distal and proximal ends of the PDN in the flap were intercalated into the defect of the PDN in volar defect group, and the proximal end of dorsal branch of PDN in the flap was also coapted to the proximal end of the proper digital nerve of the recipient finger. At the donor site, the defect of the proper digital nerve was repaired with nerve graft harvested from the proximal portion of the dorsal branch of the same proper digital nerve, and a full-thickness skin graft covered the donor site.

RESULTS

All flaps and the skin grafts of the donor site survived completely. At the final follow-up, 9 of 14 flaps had a static 2-point discrimination result below the normal threshold (< 6 mm).

CONCLUSIONS

The modified heterodigital neurovascular island flap is a useful and reliable treatment option for a digital pulp or volar defect, especially when the digital nerve defect requires repair.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Vascularized Heterodigital Island Flap for Fingertip and Dorsal Finger Reconstruction

A heterodigital vascularized island flap can functionally restore large soft tissue defects to the injured fingertip in a single stage. It is optimally used for digits of unequal length so that the donor fingertip is not violated, and the skin island is best taken from the less dominant side of the donor finger. Because it is a transposition flap with a proximal axis of rotation, its transposition arc can also reach the dorsum of an adjacent digit. This article describes how the heterodigital arterialized flap preserves the donor finger digital nerve and distal pulp, thus reducing donor site morbidity. Indications, method of flap elevation, and flap design will be reviewed to optimize case selection, minimize donor site morbidity, and enhance safety of flap elevation and transposition.