Simultaneous reconstruction of a palmar skin defect and the digital artery with an arterialized venous flap after correction of camptodactyly with severe flexion deformity

Abstract

When severe flexion deformities of fingers are corrected surgically, vascular circulation of the fingers is sometimes impaired. The poor perfusion of the digits is caused by inadvertent injuries, thrombosis formation, or vasospasm of the bilateral digital arteries of the fingers. If the vascular impairment is caused by inadvertent injury to the digital arteries, this injury should be repaired immediately using an operating microscope. Thrombosis formation and vasospasm are usually treated successfully by relaxation of the positional soft tissue tension on the affected fingers, irrigation of the wound or fingers by warm saline solution, bathing the digital arteries with local anesthesia, or application of vasodilators. Camptodactyly is a congenital anomaly of the fingers that demonstrates flexion deformities of the proximal interphalangeal (PIP) joints. Most of these deformities can be treated successfully by manipulation and splinting [1, 6, 15, 18]. However, some of them develop into severe flexion contracture of the PIP joints and demonstrate so-called pseudo-boutonniere deformities [flexion contracture of the PIP joint with hyperextension of the distal interphalangeal (DIP) joint] [8]. Surgery was performed on a 9-year-old girl to correct severe flexion contracture of the PIP joint of her right small finger resulting from camptodactyly. After extension of the finger to the neutral position, the finger failed to pink-up following release of the pneumotourniquet. This poor perfusion of the finger was improved when the PIP joint was flexed more than 40°. A skin flap including a subcutaneous vein was harvested from the distal forearm and the vein of the skin flap was interposed between the transected stumps of the palmar digital artery of the finger. The skin defect created after extension of the PIP joint was covered by the skin flap. The PIP joint was fixed temporarily at the neutral position for 5 weeks by a K-wire. The arterialized venous skin flap successfully survived without any adverse events. The finger having showed complete numbness just after surgery retuned to have normal sensation within 2 months. Nine years after surgery, the active arc of the PIP joint of the operated finger was −5° to 60°.