One-stage secondary debulking procedure: A unique technique to restore the differential contour of digit after groin flap reconstruction

Abstract

BackgroundPedicled groin flap is a reliable reconstructive method for digits. However, problems with the contour, mobility and sensation especially while providing strict thin skin coverage still exist. Patients and MethodsA total of 17 cases with 36 digits injured by trauma were identified. One-stage secondary debulking procedure was adopted for flap revision. The skin over the flap was harvested as a full thickness graft. At the dorsal side of the reconstructed digit, the subcutaneous tissue and fat was debulked till the deep fascial layer. At the volar side, the flap was debulked till the superficial fascial layer. The skin was then re-grafted. The outcomes were reviewed after 12 months follow up. ResultsThe average timing for debulking procedure after flap reconstruction was 116 days. After removal of bolster dressing 7 days after debulking, all the grafted skin took well. A mean length of 2.5cm of digit was preserved for the non-replantatable digits. The reconstructed digits achieved comparable diameter and contour with that of the contralateral side. The two-point discrimination of the injured digits of adults was 10.4 ± 1.6mm. Using a 5-point Likert scale, post-debulking digits showed statistically significant improvement compared to pre-debulking digits. The evaluation of the patients’ satisfactory outcomes of the reconstructed digits was judged as “very satisfying” in 12 patients (75%) and “good results” in four (25%). ConclusionsOne-stage secondary debulking procedure resulted in excellent functional and aesthetic outcomes for digit according to different structure of dorsal and volar sides. Level of EvidenceIV, Retrospective