Fingertip Reconstruction Using a Lateral Flap Based on the Distal Transverse Arch of the Digital Artery.

Abstract

Fingertip defect is more common in emergency hand trauma in the hospital, and most of them are accompanied by defects of the phalanx and nail bed. There are many methods in clinic for the repair of Yamano zone I fingertip injury. This article reports the repair of this type of injury using a lateral flap based on the distal transverse arch of the digital artery. From January 2015 to May 2018, the flap was used in 32 digits of 32 patients who had a fingertip injury. There were 23 men and 9 women with a mean age of 37.6 years. The injured fingers requiring reconstruction included 6 thumb, 11 index fingers, 9 middle fingers, 4 ring fingers, and 2 little fingers. Soft tissue defect range from 1.5 cm × 1.0 cm to 2.5 cm × 2.1 cm. The time of injury to emergency surgery was 1 to 7.5 hours, with a mean time of 3.2 hours. Fingertip reconstruction was performed using a lateral flap based on the distal transverse arch of the digital artery. All flaps survived completely after 1 to 1.5 years of follow-up, without evidence of postoperative insufficiency of blood supply or venous congestion. Healing of all donor sites was uncomplicated. No infectious complications were observed. The range of motion of the 32 fingers was excellent; For sweating, 17 fingers were excellent, 10 were good, and 5 were fair (poor sweating was found in the grafting site of the finger). The mean static 2-point discrimination scores on the reconstructed pulp were 5.2 mm (range, 3-9 mm). According to the Cold Intolerance Severity Score, 28 patients reported no cold intolerance, 3 reported mild cold intolerance, and 1 reported moderate cold intolerance. On the basis of the visual analog scale, 30 patients had no pain, 1 reported mild pain, and 1 experienced moderate pain. Positive Tinel sign was found in only 1 reconstructed finger. It is a new surgical technique that provides good shape and sensory function to the fingers and is simple to operate.