Advanced sensate proper digital artery escalating flaps for repair of fingertip skin defect

Abstract

Objective To investigate the feasibility of advanced sensate proper digital artery escalating flaps in reconstruction of fingertip skin defect. Methods Between January 2012 and February 2015, 15 cases (17 fingers) of fingertip skin defect accompanied with exposed tendon or phalange were treated, including 9 males and 6 females, with mean 41 years of age (range, 7-55 years). Injury resulted from hit by heavy objects in 5 cases, knife cutting in 4, machine twist injury in 4 and mass resection in 2. Fingertip defects were covered with the flaps carrying proper digital artery and nerves in order to one-stage reconstruct finger pulp epicritic sensibility and avoid onychogryphosis. Joint function was assessed with the standard set up by Chinese Medical Association Hand Surgery Branch. Results All flaps survived. One case had ankylosis of the middle interphalangeal joint caused by poor weight-bearing exercise and was improved after exercise. Two cases with large defect in the distal finger pulp had slight onychogryphosis after operation. Period of follow-up was 6-14 months (mean, 8 months). The injured fingers showed good appearance and sense, with two-point discrimination of the flap ranging from 6-8 mm. There was no linear scar or tenderness in the finger tip. Hypertrophic scar was not obvious in the flap donor area. Function assessment was excellent in 16 fingers and good in 1 finger. Conclusion The flaps result in good blood supply, good sense, no onychogryphosis and no linear scar and are easy to be operated, indicating an ideal method to reconstruct fingertip defect. Key words: Finger injuries; Surgical flaps; Escalating flaps