Clinical Effectiveness of Dorsal Branch Skin Flap of Proper Palmar Digital Artery with Distal Pedicle in Repairing of Fingertip Soft Tissue Defect: A 1-Year Prospective Study in a Chinese Tertiary Referral Teaching Hospital.

Abstract

Background: Digital island flap remains among the most useful types of providing soft-tissues coverage for defect on the fingertip accompanied with underlying structures exposure. Nevertheless, its trends of functional and aesthetic issues such as the limited length of advancement and the limited flap size are the essential disadvantages. The main objective of the study was to assess the clinical effectiveness of dorsal branch skin flap of proper palmar digital artery with distal pedicle in repairing of fingertip soft tissue defect accompanied with underlying structures exposure. Methods: This is a 1-year prospective study, in which 21 patients (24 fingers) with traumatic fingertip skin and soft tissue defects had undergone emergency repair with dorsal skin flap of proper palmar digital artery with distal pedicle. The starting point of the dorsal proper palmar digital artery which is at the connection of distal interphalangeal joint with the digital midline was selected as the rotation point of the surgical skin flap, with an incision area of 1.1 cm × 1.4 cm-2.7 cm × 2.0 cm, the pedicle of 0.8-1.7 cm and disposition of 90°-120° to cover the fingertip. Results: All flaps had completely healed postoperatively. In 2 cases, tension blisters of the flap and partial necrosis were observed, which survived after change in dressing and rational administration vasodilator medication. Patients were followed up to 6 months. Favorable appearance and function were restored, and satisfactory recovery of the sensory functions of the fingers had been achieved. The two-point discrimination of skin flap with anastomosis of nerve could reach 4.5-9.4 mm (mean, 6.80 mm). Conclusions: Repairing the fingertip skin and soft tissue defect of 2nd-5th finger via primary surgical repair with dorsal distal pedicle or proper palmar digital artery skin flap is a good technique. The high survival rate of the flap, the favorable flap's appearance, and the satisfactory recovery of the sensory functions of the fingers are among the advantages of this reconstructive technique.