Fingertip Defects Research Articles

Reconstruction of Multiple Fingertip Defects Using the Innervated Radial Artery Superficial Palmar Branch Perforator Flap

Reconstruction of Multiple Fingertip Defects Using the Innervated Radial Artery Superficial Palmar Branch Perforator Flap

Results of the application of neurovascular homodigital flaps on cutaneous defects of digital fingertips

Introduction: traumatic injuries of the hand are in the top list of working Industrial accidents. The treatment of these injuries has as goal to restore the function of fingertips, improving the patients' quality of life. Objective: Evaluate results of the application of neurovascular homodigital flaps on cutaneous defects of digital fingertips of the hand large fingers. Method: an observational and descriptive investigation was conducted in a case chain of 33 Patients at Hermanos Ameijeiras Hospital from October 2013 to January 2015. Were Neurovascular homodigital flaps applied with direct circulation (17 patients) or indirect circulation (16 patients). Results: male sex was more affected; frequency was higher Between 36 and 41 years old and over 41 years old. Four complications were confirmed representing 12%. 72.7% obtained good and excellent results with the application of these surgical techniques receiving an appropriate protector of sensibility and satisfactory cutaneous covering. Application of these procedures was 93.9% satisfied. Conclusion: The application of neurovascular flaps homodigital was established on cutaneous defects of digital fingertip of the hand large fingers.

Comparison of Homodigital Dorsolateral Flap and Cross-Finger Flap for the Reconstruction of Pulp Defects

The homodigital dorsolateral flap (HDF) was described to treat various types of pulp and fingertip defects. The aim of this study was to analyze the intermediate-term function after fingertip reconstruction with HDF and compare these results with the cross-finger flap. We analyzed a retrospective cohort of 25 patients. The HDF group consisted of 16 patients (18 fingertip defects) with a mean age of 44 years (range, 16-63 y). The cross-finger flap group consisted of 9 patients (10 fingertip defects) with a mean age of 33 years (range, 16-47 y). The average follow-up time was 12 months (range, 6-36 mo). Patients with homodigital reconstruction demonstrated better sensibility in terms of mean static 2-point discrimination. Two-point discrimination was also better when the flap was advanced compared with when the flap was rotated. Mean distal interphalangeal joint range of motion for the HDF group was significantly better compared with the cross-finger flap group. Proximal interphalangeal joint range of motion was significantly better in the HDF group. The HDF for reconstruction of pulp defects is a reliable option for 1-stage reconstruction. Related complications are minimal, and the intermediate-term functional results are better compared with cross-finger flaps. Therapeutic IV.

Clinical application of dorsal digital nerve fasciocutaneous flap with superficial vein anastomosis for repair of fingertip defects

Objective To investigate the clinical efficacy of dorsal digital nerves fasciocutaneous flap with superficial vein anastomosis in the treatment of fingertip defects. Methods From January 2016 to February 2017, 25 cases (25 fingers) of fingertip defects were treated with proximal dorsal digital nerve fasciocutaneous flap. After the flap was transferred to cover the wound, the stump of a superficial vein retained at the proximal end of the flap was anastomosed to the stump of fingertip subcutaneous vein for reconstruction of flap venous circulation. Results All the flaps survived uneventfully. The appearance of flaps was good without blisters and purple skin 2 weeks after operation. The postoperative follow-up time ranged from 6 to 8 months with an average of 6.5 months. The flap had good appearance, no obvious bulky shape and soft texture. Some flaps had pigmentation. The skin pain and temperature sensation were restored. The joints of the fingers were in good motion. All the skin grafts survived. Conclusion The dorsal digital nerve fasciocutaneous flap with superficial vein anastomosis for repair of fingertip defects overcomes the shortcomings of the traditional flap with poor backflow, and the survival of the flap is effectively guaranteed. Key words: Surgical flaps; Treatment outcome; Fingertip defects; Fascial pedicle; Superficial vein anastomosis

Ulnar Thumb Pulp Reconstruction Using the Anterograde Homodigital Neurovascular Island Flap.

The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks. We describe an anterograde homodigital neurovascular island flap that provides both sensate and durable coverage of the ulnar thumb pulp. The flap uses innervated glabrous tissue, limits donor site morbidity to the thumb and first web space, and does not require microvascular anastomoses or nerve coaptation. The flap has been previously described for nonthumb fingertip injuries, but it has not been applied to the thumb. We discuss several important technical modifications that are essential to raising and insetting this flap in the thumb, review potential pitfalls, and highlight key steps to ensuring judicious intraoperative decision making and success.

Modified method of Hallux toe nail flap for finger tip reconstruction and donor site repair

Objective To discuss the modified method and clinical effect of free hallux toe nail flap for reconstruction of composite tissue defect at finger tip and repair of its donor site. Methods Partial nail bed at fibular side of hallux was cut and combined with toe tip skin to form hallux toe nail flap. The reconstruction of finger tip defects was achieved by free hallux toe nail flap transplantation. The donor site of hallux was sutured directly. Nail bed wound was healed by itself without skin graft or flap repair. From May 2013 to April 2015, 13 cases (15 fingers) had partial nail bed and skin defects at finger tip and no obvious distal phalanx defects, which were repaired by this method. Results All the patients were follow-up for 3 to 12 months. All the free hallux toe nail flap graft survived. The finger tip appearance and nail growth were close to normal. The function of interphalangeal joint was good. Hallux nail was nearly complete with good appearance and without obvious defect. No local pain, ulceration, and sensory disorder occurred at hallux donor site. Conclusion Hallux toe nail flap is an ideal method for reconstruction of composite tissue defect at finger tip. The improvement of donor site repair method can make better appearance of toe tip and nail without obvious sequelae. Key words: Finger injuries; Surgical flaps; Free tissue flaps; Fingertip defects

Reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip

Objective To explore the clinical outcomes of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip. Methods From March 2014 and June 2016, 25 patients (30 fingers) of fingertip soft tissue defects were treated using reverse dorsal digital island flap with cutaneous branches of proper digital nerve. The proper digital cutaneous branches of the flap were sutured with the digital nerve of the wound. The fingertip defect area ranged from 1.4 cm×1.6 cm to 2.0 cm×3.5 cm (average, 2.1 cm×2.5 cm). The flap area was enlarged by 10%. The donor sites were covered with autologous full-thickness skin. Results All the flaps survived. All the donor and recipient wounds achieved primary healing. Venous crisis occurred in one case which healed after the removal of some sutures. Postoperative follow-up period ranged from 6 to 18 months. The shape of the flaps was plump and the texture was soft. Partial superficial sensation of the flaps recovered without donor site pain and interphalangeal joint dysfunction. The two-point discrimination ranged from 5 to 8 mm, with the average being 5.7 mm. According to the functional evaluation standards issued by Hand Surgery Society of the Chinese Medical Association, the results were excellent in 17 cases, good in 8 cases. Conclusion The application of reverse dorsal digital island flap with cutaneous branches of proper digital nerve for repair of soft tissue defects of the same fingertip can achieve good sensory recovery. Key words: Finger injuries; Surgical flaps; Treatment outcome; Sensory reconstruction

The finger lateral local flaps to repair clinical application of finger tip defect

Objective To discuss the clinical influence and advantages of applying the local flap of finger tip lateral skin to repair the fingertip defective injuries. Methods From August, 2013 to December, 2015, used the way of local the flap of finger tip lateral skin to repair the first-fourth fingertip defects for 32 cases and 32 fingers, among which there were 20 males and 12 females; finger categories: 11 thumbs, 9 index fingers, 8 middle fingers and 4 ring fingers. The defective area of fingertips was 0.5 cm×0.8 cm-1.0 cm×1.5 cm, all with bone exposure, 23 cases had defects at the end part of phalanx, 32 cases had different extent of nail bed defects. Reasons for the injuries: 13 cases of grind injuries, 11 cases of punch pressing injuries, 8 cases of sharp tool cutting injuries. The time from injury to the treatment was 0.5-3.0 h, all of them had no associated injuries. Results Thirty-two cases of finger flaps all survived, with the follow-up for 3-24 months and average follow-up of 6 months, the flaps were slightly bloated after 3 months comparing with the normal skin, there was no contracture in the flap area and pedicle scars, two-point discrimination was 4-5mm, the farinterphalangeal joint flexion was normal. Conclusion The local flap of fingertip lateral skin can repair the defects of fingertip with less scar, not bloated flap, satisfying appearance, operation is simple, and good function, so it’s the ideal way to repair the defects of fingertip. Key words: Finger tip defect; Surgical flap; Local transfer flap; Microsurgical technique

Effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand

Objective: To investigate the effects of vacuum sealing drainage technique in acute and chronic suppurative tenosynovitis of hand. Methods: A total of 9 cases acute and chronic suppurative tenosynovitis patients from January 2013 to April 2015 in Puai Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology were retrospectively reviewed. There were 6 males and 3 females, aging from 27 to 65 years, the average age was 55 years. There were 3 cases of index finger, 3 cases of middle finger, 2 cases of ring finger, 1 case include three fingers. The infection causes included stabbing with fishbone in 3 cases, stabbing with animal bone fragments in 3 cases, wound by sawdust in 3 cases, meat grinder injury in 1 case, multiple fingers crush injury postoperative infection of garbage truck in 1 case. Bacterial infection included 2 cases with Staphylococcus aureus, 2 cases with Staphylococcus epidermidis, 1 case with normal Escherichia coli, 1 case with mixed infection of Enterobacter aerogenes, Klebsiella oxytoca and Staphylococcus, 1 case with Bauman Acinetobacter bacillus, 1 case with Proteus mirabilis and 1 case of no growth of pathogenic bacteria culture. After thorough debridement, vacuum sealing drainage was used to observe the characteristics of irrigation fluid, the formation of cavity inflammation, the prognosis of infection and the recovery of finger function. Results: Seven patients with suppurative tenosynovitis were treated for 7 to 14 days, replaced the vacuum sealing drainage dressing once; 1 patient was an illustration of the finger tip defect flap infected patients after 21 days of treatment, replaced the vacuum sealing drainage dressing twice, 1 patient was an illustration of the central refers to trauma, postoperative infection patients 28 d, replaced three times in the VSD. The follow-up time was 3 to 12 months (mean 8.2 months), 7 patients without tendon necrosis, secondary suture with no infection, 2 cases of traumatic surgery of patients with infection, tendon necrosis was removed, the infection has been effectively controlled, secondary suture with no infection. There were 6 cases were good and 3 cases were poor in the evaluation of postoperative finger function. Conclusion: Thoroughly debridement after vacuum sealing drainage in the treatment of suppurative tenosynovitis of hand has satisfactory curative effect.

Anastomosis of dorsal branch of the proper digital nerve dorsal distal interphalangeal joint perforator flap to repair finger tip defect of skin tissue

Objective To Summarize the application of digital artery dorsal distal interphalangeal joint perforator flap to repair finger tip skin defect, and at the same time, the method and effect of anastomosis of finger dorsal branch of digital nerve sensory reconstruction. Methods From September 2012 to March 2015, 78 patients 92 fingers were treated in Orthopedics Department of Jinshan Branch Hospital of the Sixth People′s Hospital of Shanghai, all patients with finger artery distal interphalangeal joint dorsal cutaneous branches of the dorsal flap pedicled with retrograde, transferred to repair the skin defect of finger end, and anastomosis of dorsal branch of the proper digital nerve reconstruction. Results Postoperative vascular crisis occurred in 8 cases, 2 cases of partial flap necrosis and healed after symptomatic treatment.All flaps survived, the wounds healed in I stage, and the donor site healed in I stage.All the 73 cases were followed up, the follow-up period ranged from 3.0 to 12.0 months, an average of (7.8±2.5) months.The postoperative appearance and feel good, soft texture, abrasion resistance, no tenderness, cold resistance, dynamic two-point recovered to 4.0-8.0 mm, average (5.3±0.9) mm.Static two-point discrimination was 4.0-9.0 mm, average (5.8±1.2) mm.The method of TAM was used to determine the function of the 67 fingers, good for the 7 finger, but also for the 5 finger and the difference of the 0 finger.The excellent and good rate was up to 93.7%. Conclusion The operation without sacrifice of major arteries and nerves by finger, the middle finger dorsal skin for non functional surface area, and at the same time by anastomosis of dorsal branch of the proper digital nerve reconstruction, without surgery two times, is one of the ideal surgical repair of skin defect of the finger end. Key words: Dorsal branch of digital artery; Perforator flap; Skin defect of finger end; Refers to the inherent nerve

Why borrow from Peter when Paul can afford it? Reverse homodigital artery flap for fingertip reconstruction.

Background:Fingertip injuries that are complicated by pulp loss, bone or tendon exposure will need a flap cover. Cross finger flap is commonly used to cover such defects. However, patients are apprehensive about injuring the uninjured finger as a donor site. Reverse homodigital artery flap (RHAF) can provide reliable vascularised cover to such defects.Aims:This study aims to assess the functional and aesthetic outcomes along with the patient satisfaction of RHAFs done for fingertip defects.Materials and Methods:RHAFs done in 18 patients operated between August 2015 and October 2016 were retrospectively analysed on flap survival, sensory recovery, range of movements, hypersensitivity, cold intolerance, flexion contracture and donor site morbidity.Results:Seventeen of the 18 flaps done survived completely. One flap had partial necrosis of 3 mm that healed conservatively. Middle finger of the right hand was the most commonly injured finger. Touch, pain and pressure sensations recovered in 8–12 weeks. Two-point discrimination was 4.5 mm at 6 months. The deficit of 5° s was present at distal interphalangeal joint during active flexion at 6 months. Cold intolerance and flexion contracture were not seen and 2 instances of hypersensitivity at 2 months got cured conservatively after 4 months. Overall satisfaction of patients was 8/10.Conclusion:RHAF provides single staged well-vascularised cover for fingertip injuries with good sensory recovery without damaging the adjacent uninjured finger. Hence, it can be a reliable flap for fingertip reconstruction in selected cases.

Cross finger flap cover for fingertip injuries

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Fingertip injuries are the most common form of hand injuries. Restoration of the anatomy is a technical challenge and is one of the basic tenets of the management of fingertip injuries. The cross finger flap is simple and easy to do and is a very useful tool in reconstruction of the pulp of the finger. The project aimed to study the efficacy of cross finger flap in the coverage of fingertip injuries.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted on a prospective basis in Sri Ramachandra University Hospital in Chennai. The study period was from May 2013 to August 2016. All adults who had fingertip injuries who had undergone cross finger flap cover were included in the study. Patients who had other flaps for reconstruction and who were lost for follow-up were excluded from the study. Preoperative parameters which were recorded were mechanism of injury, size of defect, size of the flap, location of donor site and method of coverage of secondary defect. Outcome measures recorded were flap viability, flap sensibility using two-point discrimination, range of motion of fingers, grip strength and presence of other complications</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">40 patients were included in the study. Six were lost for follow-up. Mean follow-up was 14 months. All flaps survived. Full range of motion was obtained in 87% of patients. Average grip strength was 94% for dominant hand injuries and 78% for non-dominant hand injuries. Mean quick DASH score was 10.5. Mean two-point discrimination was 15.4 mm. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Cross finger flap is very effective for coverage of volar fingertip defects with minimal residual problems.</span></p>

Digital artery dorsal branch island flap combined with webspace advance flap for treatment of fingertip defects

目的 评估指动脉背侧支逆行岛状皮瓣联合指蹼推进皮瓣修复指端缺损的临床疗效。 方法 自2013年5月至2015年2月，我们共收治指端缺损患者22例，采用指动脉背侧支逆行岛状皮瓣修复指端缺损，供区采用指蹼推进皮瓣修复9例（皮瓣组），游离植皮修复13例（对照组）。比较两组手术时间、住院时间、皮瓣大小以及术后功能恢复等指标。 结果 术后所有皮瓣均存活良好，未出现坏死或部分坏死。所有患者均获得随访，时间为6~24个月，平均13.6个月。两组间性别、年龄以及住院时间等指标差异均无统计学意义（P>0.05）。手术时间及岛状皮瓣长度，皮瓣组小于对照组，差异有统计学意义（P S3 18例、S3 2例, S2 1例。皮瓣供区感觉恢复>S3：皮瓣组6例，对照组2例；S3：皮瓣组2例，对照组3例；S2：皮瓣组1例，对照组5例；S1：对照组3例。皮瓣组病例术后均无指蹼挛缩发生。 结论 采用指蹼推进皮瓣修复指动脉背侧支岛状皮瓣供区创面，可显著改善供区创面皮肤质地及浅感觉恢复，无指蹼挛缩，在保持良好疗效同时进一步缩短手术时间并简化术后护理。

Super Kutler flap: an alternative technique for reconstruction of fingertip defects.

IV.

Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator.

Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator.

Fingertip reconstruction with a posterior interosseous artery perforator flap: A minimally invasive procedure for donor and recipient sites

A posterior interosseous artery perforator flap is used for small defects and leaves no functional disturbance at the flap donor site. This report aimed to describe our experience with the transfer of this flap for fingertip defects and the evaluation of postoperative function. In total, 11 flaps were used for 13 fingertip reconstructions in 11 patients. Two patients had two finger defects simultaneously covered with one bridge flap, and five flaps were harvested in true perforator flap style. Over a 10.6-month mean follow-up, static and moving two-point discrimination were 8.8 and 6.1mm, respectively, and patients returned to work approximately 2 months after surgery. There were no complications at the donor sites. A posterior interosseous artery perforator flap was a useful choice for fingertip reconstruction, with good sensory recovery and no donor site morbidity, and the patients could return to daily living quickly.

Sensate M-shaped digital artery flap for repairing fingertip defect caused by degloving injury in children

Objective To investigate the clinical outcomes of M-shaped digital artery flap with nerve coaptation for treatment of fingertip degloving injury in children. Methods From March 2013 to March 2014, 9 pediatric cases of fingertip degloving injury were treated with M-shaped digital artery flap. The size of the flaps ranged from 3.0 cm×1.0 cm to 3.5 cm×1.2 cm. The dorsal cutaneous nerve inside the flap was coapted to the digital nerve on one side to restore sensation of the fingertip. Results All 9 flaps survived completely. The patients were follow-up for 6 to 14 months. The color, texture and contour of the flaps were good. Two-point discrimination was 6.0 to 9.0 mm on the flap. Joint movement of the fingers was normal. According to the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society, the results were rated as excellent in 7 fingers and good in 2 fingers. No contracture complication occurred at the donor site. Conclusion The surgical procedure of M-shaped digital artery flap transfer is simple. The nerve coaptation makes it a sensate flap. It is an ideal method to treat fingertip degloving injuries. Key words: Finger injuries; Surgical flaps; Child

Double V-Y Flap to Cover the Fingertip Injury: New Technique and Cases

The volar V-Y flap is used in transverse or dorsal oblique amputations in fingertip injuries; however, its use is contraindicated in patients with volar oblique amputations and cannot advance distally enough to cover the defect. The aim of this report is to describe a technique of double V-Y flap to cover fingertip defects in which a simple V-Y flap is not enough. This technique allows advancement between 30% and 50% farther than the original, simple V-Y flap. Report of cases a series of fingertip amputation covered with this technique. This technique was performed in 7 patients between 25 and 64 years old, with transverse, volar and dorsal oblique defects in the fingertip. The advancing of the flap was between 3 and 5 mm. There were no infections or necrosis of the flaps. In all patients there were acceptable aesthetic results with 2-point discrimination between 4 and 6 mm in the proximal flap and up to 10 mm in the distal flap with a minimum follow-up of 6 months. With this double V-Y flap, we have seen a good coverage even in volar oblique amputation. In addition, it is possible to advance up to 5 mm more with this second V-Y flap without compromising the vitality of the flap. It is a simple and reproducible technique that can be used on any finger, with good results, without flap necrosis.

Fenestrated Adipofascial Reverse Flap: A Modified Technique for the Reconstruction of Fingertip Amputations

ABSTRACTAims of the Study: Fingertip injuries can be treated in different ways, including shortening with primary closure, skin graft, and local or distant flaps. Several local flaps for the reconstruction of the amputated fingertip were described. We present our experience with a new concept of homodigital adipofascial reverse flap that avoids the second surgical stage and allows a complete and anatomically perfect reconstruction of nail bed, with preservation of the nail lamina. Materials and Methods: Between March 2014 and February 2015, five patients with digital amputations (distally to the nail matrix) were treated using the Fenestrated Adipofascial Reverse (F.A.R.) flap. The patients were evaluated measuring 2-point discrimination (2PD) value and range of motion of the distal interphalangeal joint (DIP). Scar evaluation was performed using the Vancouver Scar Scale (VSS). Results: All the flaps completely survived. A normal nail grow has been observed in first two-three months of post operatory follow-up. Length of the digits was preserved and good aesthetic as functional outcome were archive. The F.A.R. flap provided excellent coverage of fingertip defects and preserved finger length. After 1 year of follow, the mean static 2PD value at the reconstructed finger was 4.2 mm (range 3-5 mm), reconstructed fingers' mean range of motion for the DIP joint was 78 degrees and the VSS score ranged from 0 to 2 (mean score: 0.6). No complications were reported. Conclusions: F.A.R. flap is one of the most useful techniques in order to achieve all the goals in fingertip reconstruction.

Transfer of digital artery terminal dorsal perforator propeller flap at the middle phalanx for coverage of fingertip defects

目的 探讨指中节背侧螺旋桨皮瓣修复指端皮肤缺损的方法及临床疗效。方法 自2012年1月至2015年7月，我们对21例示中环小指末节皮肤缺损患者采用中节指动脉终末背侧穿支螺旋桨皮瓣修复，供区切取面积为1.5 cm×1.0 cm～2.5 cm×2.0 cm。 结果 术后21例皮瓣全部存活，2例出现供区植皮部分坏死，通过换药，创口愈合良好。术后随访时间为3～18个月，患指外形良好，不臃肿，皮瓣色泽、质地良好，患指各关节活动正常。按中华医学会手外科学会上肢部分功能评定试用标准评定：优18例，良2例，可1指，优良率为95.2%。 结论 中节指动脉终末背侧穿支螺旋桨皮瓣符合宁简勿繁，宁近勿远，以次要部位修复重要部位的原则，术后治疗效果良好，是修复手指末节皮肤缺损的可靠方法。