Digital Artery Perforator Flap Research Articles

Digital Artery Perforator Flap for Fingers Reconstruction: A Meta-Analysis Study with Clinical Cases

Digital Artery Perforator Flap for Fingers Reconstruction: A Meta-Analysis Study with Clinical Cases

Anatomic pattern of perforator arteries from proper digital arteries in human triphalangeal digits

IntroductionThe localization of the perforator artery for the performance of digital artery perforator (DAP) flaps poses a challenge. This study aims to describe the anatomical pattern of the perforator arteries originating from the proper digital artery in fresh cadaveric triphalangeal digits and to use this pattern as a point of reference for performing these flaps. Material and methodWe performed a descriptive anatomical study on 28 fresh cadaveric hands (14 male, 14 female; 10 right hands, 18 left hands) after injecting the arterial system with latex. Digital photographs were taken of each specimen after dissection and the number of perforator arteries in each finger (second to fifth), phalanx (proximal, middle and distal) and finger side (radial or ulnar) were obtained by analysis in Adobe Photoshop CS6. ResultsWe obtained statistically significant results when comparing the means of the number of perforator arteries between fingers, phalanx, finger side, gender and laterality. When analyzing the number of perforator arteries in each phalanx third in each finger, we found that more than 75% of specimens had at least one perforator artery in the two distal thirds of the proximal phalanx and the three-thirds of the middle phalanx and more than 50% had at least one in the proximal third of the distal phalanx. ConclusionsWe present a homogeneous perforator artery anatomic pattern, by finger, phalanx, finger side, gender and laterality, consisting of a high density of perforator arteries in the distal proximal phalanx region, throughout the middle phalanx and in the proximal distal phalanx region, which would be the areas of greatest certainty to help predict the favorable evolution of a digital artery perforator flap in the fingers.

Double-pivot proper digital artery perforator flap for fingertip reconstruction

BackgroundDorsal flap based on proper digital artery perforator has been commonly used in wound coverage of fingertip; yet a small diameter and short length poses a risk of pedicle kinking or occlusion. The present study aims to present our preliminary results of using a double-pivot perforator flap based on the end dorsal branch of proper digital artery to repair finger pulp defect.MethodsWe designed a double-pivot flap based on the end-dorsal perforator branch of proper digital artery, raised from the dorsal aspect of the middle phalanx, with inclusion of both the perforator and a section of the trunk of the artery. This modified procedure forms a pedicle with a larger diameter and length than traditional designs. Twelve patients (12 fingers) each with a soft-tissue defect of the fingertip were successfully treated and followed up in this retrospective study.ResultsAll the flaps survived without showing any signs of necrosis; three cases presented with transient venous flow disorder, these self-resolving without requiring any additional treatment. At final follow-up (12–33 months, mean 20 months), mean static two-point discrimination on the flap was 7.0 mm (range, 6–9).ConclusionThe double-pivot proper digital artery flap serves as a reliable option in fingertip reconstruction offering added benefits of having greater rotation flexibility, a lower risk of vessel kinking or occlusion, and good recovery of cutaneous sensation.

The Qatari Flap for Fingertip Reconstruction: Versatility, Reliability, Clinical Applications, and Review of Literature

Background: Fingertip injuries are common; when the bone is exposed, it requires more than skin to cover the defect. After the introduction of the concept of perforator flaps, trials have been made to reconstruct finger defects with perforator flaps. Here, we describe a series of fingertip injuries that were treated with reverse flow island finger perforator flap. Methods: We had 36 patients from January 2019 to June 2021, most of them male workers. We reported on the sizes of the defects and donor sites, the need to cover the pedicle with a skin graft, and complications. Patients were followed up for a period of 6 months, and the detailed elevation technique was mentioned. Results: Thirty-four flaps survived completely. In 50% of the cases, patients had congestion and epidermolysis with preserved underlying flap, which had normal healing course. Two patients with diabetes had infections; one of them had 40% necrosis of the flap, and one additional case had superficial eschar with preserved underlying flap tissues. Conclusions: Fingertip reconstruction rather than bone shortening is preferred to maintain the finger length. Multiple choices were suggested, but this flap had the disadvantage of limited coverage. After introducing the concept of perforator flaps into finger reconstruction, still more choices were added. The retrograde island digital artery perforator flap is a reliable choice, which is done in one stage and does not require loss of the digital artery.

The Bridged Digital Artery Perforator Flap as an Alternative Reconstructive Option for Dorsal Digital or Toe Soft Tissue Defects.

Dorsal digital soft tissue defects are considered among the most challenging to reconstruct. Numerous treatment options are proposed, including advancement flaps, antegrade, retrograde flow flaps, adipofascial flaps, and digital artery perforator flaps. However, the optimal treatment remains controversial. The concept of the "bridge principle," consisting of the indirect transfer of the flap to the defect area through a muscular bridge, has recently introduced by authors for medial canthal reconstruction. The aim of the study was to examine the feasibility of its application in digital reconstruction for dorsal defects and the development of a new flap. The utilization of the dorsal subcutaneous adipofascial digital or toe tissue as a "bridge" led to description and development of bridged digital artery perforator flaps as an alternative treatment of such defects. From November 2017 to September 2019, a series of 14 patients (mean age of 57.1 years) suffered from dorsal digital or toe soft tissue defects of different dimensions and sustained reconstruction with this new technique. Twelve digits and 2 toes have been concerned. The mean size of the defects was 1.3 × 1.1 cm. All flaps survived without a sign of venous congestion. No functional digital or toe problems were observed during the follow-up period (mean of 11.6 months). Minor wound dehiscence presented in 2 cases (2 of 14 [14.3%]) and a transient skin swelling around the flap in 1. A new concept was introduced to resolve a challenging problem. Initial outcomes are very encouraging. These flaps could be a valuable and reliable reconstructive option.

Reconstruction of Digit Soft Tissue Defects With the Fourth Common Digital Artery Perforator Flap

The hand has unique skin characteristics. Intrinsic flap donors are limited due to functional specificity and compactly connected structures. The hypothenar area is a reliable option for the reconstruction of finger defects. We performed anatomic studies elucidating the blood supply of this area and hypothesized that the fourth common palmar digital artery perforator free flap can be used to reconstruct soft tissue defects in fingers with minimal donor site morbidity. From November 2017 to February 2020, 30 procedures of fourth common digital artery perforator free flaps were performed to cover digital skin defects. A retrospective chart review was performed, and the cases were analyzed. The mean patient age was 42.4 years (range, 1-75 years; median age, 40 years). Defects were located at the fingertip (n= 12), the dorsum (n= 3), the palmar (n= 9) aspect of the finger, and both the dorsal and palmar aspects of the finger (n= 6). Indications included emergent coverage (n= 13), coverage after necrosis (n= 11), oncological resection (n= 1), and contracture release (n= 5). The defect size ranged from 1.5× 0.8 cm (1.2 cm2) to 6× 2.5 cm (15 cm2). The perforator was located approximately 1 cm proximal to the distal palmar crease as it arose from the fourth common digital artery at a right angle. It continued to the ulnar border of the hand through the superficial fasciaof the hypothenar muscles before running in a proximoulnar direction toward the dorsum of the hand. The diameter of the perforator was between 0.5 and 0.7 mm. All flaps survived. One case required a split-thickness skin graft for donor site closure, and all others could be closed primarily. The fourth common digital artery perforator is a versatile flap and can be used for both palmar and dorsal defects, including for the fingertip. The location of the perforator used differs from previous descriptions but is routinely and reliably located. Therapeutic IV.

Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries.

The aim of this study was to evaluate the long-term clinical outcomes of innervated digital artery perforator (IDAP) flap in the treatment of patients with fingertip injuries. Eighty-three patients (93 fingers; 70 male, 13 female; mean age = 35.2 years, age range = 5-65) with fingertip injuries who underwent acute or late reconstruction with IDAP flap between 2011 and 2016 were retrospectively reviewed. The mean age was 35.2 (range = 5-65) years. Reconstructions performed in 85 fingers (91.4%) were acute, and 8 fingers (8.6%) were late. Hypersensitivity, cold intolerance, and patient satisfaction were questioned as subjective evaluation parameters. The objective patient outcome evaluations consisted of static two-point discrimination (s2PD) test, the Semmes-Weinstein monofilament (SWM) test, and range of motion of the reconstructed fingers. The mean follow-up period was 33.1 (range = 12-62) months. The smallest flap size was 1.6 x 0.7 cm; the largest flap size was 4 x 2 cm. All flaps survived completely. There was no postoperative infection or donor site morbidity. Hyperesthesia was observed in 4 fingers (4.3%), of which 3 were mild and 1 was moderate. Eighteen patients (18 fingers, 19.3%) experienced mild cold intolerance on reconstructed fingertips. 75 patients (90.3%) were highly satisfied, and 8 patients (9.7%) were satisfied with functional and aesthetic results of their fingertip reconstructions. No range of motion limitation was observed in any joints of 90 fingers (96.8%). The s2PD in the flaps ranged from 2mmto 6mm(mean = 3.71 ± 0.97 mm), compared with 2mmto 5mm(mean = 2.73 ± 0.66 mm) on the contralateral hand. TheSWMtest results of the flaps ranged from 2.44 to 4.56, compared with 2.44 to 4.31 on the contralateral hand. The difference regarding s2PD and SWM test was statistically significant (P < 0.001). IDAP flap seems to be a sensate, reliable, and versatile flap that can be used in acute and late reconstructions of any type of fingertip defects. Satisfactory functional and aesthetic results can be achieved with better sensorial results and lower complication rates compared to other conventional reconstruction techniques. Level IV, Therapeutic Study.

Digital Artery Perforator Flap Use in Reconstruction of Fingertip Defects

Amac: Parmak ucu defektlerinin rekonstruksiyonunda dijital arter perforator flebi kullanarak yapilanrekonstruksiyonlar ile ilgili deneyimimizi bildirmeyi amacladik. Gerec ve Yontem: Parmak defektleri nedeniyle ameliyat edilenve dijital arter perforator flep ile rekonstruksiyon yapilan 8 hasta calismaya dahil edildi. Hastalar etyoloji, cinsiyet, yas, komorbidite ve sonuclar acisindan degerlendirildi. Fleplerin boyutlari 20 x10 mm ile 25 x20 mm arasindaydi. Bulgular: Hastalarin ortalama yasi 43,6 ( 19-66) idi. 8 flebin 6'si tam olarak sag kaldi ve sorunsuz iyilesti. Bir flepte kismi cilt nekrozu yasanirken 1 flep ise tamamen kaybedildi. Hicbir hasta soguk intoleransindan veya eklem kontrakturunden sikayetci degildi. Hastalardan birinde hafif tirnak deformitesi olustu. Sonuc: Dijital arter perforator flebi(DAPF), komorbiditesi olmayan ve sigara icmeyen hastalarda parmak ucu defekti rekonstruksiyonlari icin guvenilir ve cok yonlu bir fleptir. Tek asamali ameliyat proseduru, flebi hazirlama kolayligi, hizli iyilesme ve dijital arterlerin korunmasi en onemli avantajlaridir.

The ulnar digital artery perforator flap for little finger reconstruction

An ulnar digital artery perforator flap has been used for little finger reconstruction. The flap is found to have a reliable blood supply, it is being perfused by a constant sizeable perforator. This paper helps describes a case report of a patient with injury to little finger with exposed bone for which a ulnar digital artery perforator flap was done. The position of the perforator was confirmed intraoperatively by an exploratory incision before committing to the distal incision. The flap used to cover the flexor aspect of the little finger has given good result.

Patient satisfaction after innervated digital artery perforator flap for fingertip injuries.

The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to analyze the relationship between patient satisfaction and outcome measures. A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in this retrospective study. Patients' injured finger and defect type were recorded. At the last follow-up, the static two-point discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We performed correlation and logistic regression analyses between patient satisfaction and outcome measures. The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from 2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended. IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time. Level IV, Therapeutic study.

Assessment of soft tissue reconstruction of the thumb after injuries

Background: This study is to formulate a strategic approach for soft tissue reconstruction of the thumb and study of different modalities of soft tissue reconstruction of the thumb and try to clarify advantage and discuss complication of each modality.Methods: This is a prospective study done on 20 patients with thumb defects and deformities, presented at Menoufia University and Al-Ahrar Zagazig Teaching Hospitals during the period from January 2017 to July 2019. They were 14 Males and 6 females classified according to age, sex, type of trauma, dominant hand, type of flap used for reconstruction.Results: The most type of injury was trauma in all technique accept digital artery perforator (DAP) flap and groin flap of the half patients were trauma (50%) and other half were post burn (50%). Most patients were early timing of interference in all techniques accept replantation was immediate time of interference (100%) and groin flap was late time of interference (100%). Most patients in Moberg flap had minimal scare complication (60%). Whereas half patients had minimal scare complication in replantation, little flap and DAP flap (50%, 50% and 50%). While half patients had volar contracture, graft complication in thumb cross finger and groin flap (50% and 50%).Conclusions: Replantation is the first choice for thumb amputations proximal to the base of the distal phalanx. It is impossible or fails, other methods of thumb reconstruction. Thumb cross finger flap is an excellent reconstructive technique for larger volar and tip defects of the thumb, up to 2-3 cm2.

Finger defect coverage with digital artery perforator flaps

AimThe aim of this paper is to demonstrate the advantages of using local resources in the coverage of such defects. Our approach in fingers’ defects is the use of local perforator flaps, both as propeller flaps or bi-lobed pedicled flaps. Patients and methodsAfter performing an anatomical study on cadaver segments injected with latex followed by transparentation, 81 local perforator flaps in 80 patients during a period of 10 years (2007–2016), i.e. 47 digital artery propeller perforator flaps (DAPP), 10 island transposition perforator flaps (DATP), and 24 bi-lobed pedicled perforator flaps (BLP) were performed in our department. The patients were evaluated regarding finger mobility (ROM), two-points discrimination (TPD), and degree of satisfaction (DS) from cosmetic point of view. ResultsThe mean interval for social and professional reintegration was 12 days. As complications, we registered only venous congestion in 7 cases followed by epidermolysis in 4 cases and superficial necrosis in 3 cases, which healed by reepithelialization. The range of motion (ROM) of the reconstructed fingers was normal in all the patients. All the flaps regain a satisfactory degree of sensibility (TPD between 4 mm and 14 mm). The DS was relatively high, with 67 patients very satisfied, 11 satisfied, and 2 unsatisfied. ConclusionsThis fast and less invasive method, which replaces like-with-like, allows an early and good reinervation and a rapid social and professional reintegration, proves to be a very reliable alternative in digital defects coverage.

Complicated fingertip defects: Clinical approach to their reconstruction and the flaps that can be used in emergency settings

Aim: Numerous flaps have been described for the reconstruction of complicated defects of the fingertip. The aim of this study was to evaluate our experience on flaps that can be used in emergency settings, and analyze the outcomes of these procedures. Materials and Methods: A retrospective analysis of 81 patients, who presented to the emergency unit with complicated fingertip defects between 2009 and 2014 and in whom replantation was deemed unsuitable due to various reasons including crush or avulsion type of injury mechanism, absence of the amputated part, or unrepairable vascular injury in the amputate, was carried out. Results: Eighty-nine flaps were performed in 81 patients. The defects were repaired with V-Y advancement flaps in 57% (45 patients – 51 fingers) of the defects, kite flap in 15% (13 patients – 13 fingers), cross-finger flap in 12% (11 patients – 11 fingers), Kutler flap in 6% (4 patients – 5 fingers), digital artery perforator flap in 6% (4 patients – 5 fingers), and thenar flap in 4% (4 patients – 4 fingers) of the injuries. One patient operated with the digital artery perforator flap, and one other operated with the kite flap, developed partial flap necroses. There were no other complications. Conclusion: Functional and esthetic restoration of soft tissues in the fingers is possible with the use of appropriate flaps and meticulous surgical technique.

Comparison of Innervated Digital Artery Perforator Flap Versus Homodigital Reverse Flow Flap Techniques for Fingertip Reconstruction

The aim of this study was to investigate and compare outcomes of 2 different flap techniques for fingertip reconstruction: innervated digital artery perforator (IDAP) flap and homodigital reverse-flow flap. Medical records of 33 patients who underwent fingertip reconstruction either with an IDAP flap (15 patients) or with a homodigital reverse-flow flap (18 patients), between 2014 and 2016, were evaluated retrospectively. In both study groups, full-thickness skin grafts harvested from the proximal/volar side of the forearm were used to cover the flap donor site. Flap survival, venous congestion, cold intolerance, static 2-point discrimination, flap size, duration of surgery, time to return to work, proximal and distal interphalangeal joint range of motion, Disability of the Arm, Shoulder, and Hand questionnaire scores, and follow-up time were evaluated. All the major outcomes, including flap survival, cold intolerance, static 2-point discrimination, flap size, time to return to work, range of motion values for proximal and distal interphalangeal joints, Disability of the Arm, Shoulder, and Hand questionnaire scores, and follow-up time, were similar between the 2 flap methods. Mean duration of surgery was shorter in the IDAP flap group. Marginal flap necrosis occurred in 1 IDAP flap, and there was complete survival of the remainder of the flap after debridement. Temporary venous congestion was seen in 3 IDAP flaps, all of which resolved with nonsurgical measures. Similar success rates and satisfactory outcomes were achieved with IDAP flap and reverse-flow flap techniques used for fingertip reconstruction. Therapeutic IV.

Innervated Digital Artery Perforator flap を用いて再建した指尖部掌側皮膚欠損症例の検討

Innervated Digital Artery Perforator flap を用いて再建した指尖部掌側皮膚欠損症例の検討

Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept

Reconstruction of the finger and thumb dorsum has been considered difficult because of the need for a thin and flexible flap, and the surrounding tissue is sometimes insufficient for a local flap. The purpose of this report is to describe our concept for finger and thumb dorsum reconstruction with free-style perforator flaps and our clinical experience with transfer of various perforator flaps. Thirty-two finger dorsum defects in 32 patients were covered with pedicled free-style perforator flaps. The perforator origin was a digital artery perforator in 22 cases and a dorsal metacarpal artery perforator in 10 cases. The flap style was advancement type in 11 cases, rotation in 2, propeller in 14, and adipofascial in 5. The mean size of the digital artery perforator flap was 3.4 cm2 and that of the dorsal metacarpal artery perforator flap was 7.9 cm2. All flaps, except for two propeller flaps with 180 degrees rotation, survived completely. These flaps were of elongated style, and the length-to-width ratios were approximately 3:1 and 3.5:1, respectively. There are multiple perforators in the finger and thumb dorsum region from the proper digital artery, which are suitable for pedicled free-style perforator flaps. These perforators increase flap flexibility and reliability in clinical applications.

Corrigendum.

Kostopoulos E, Agiannidis C, Konofaos P, et al. Predictable pattern digital artery perforator flap: an alternative concept in digital reconstruction. Hand (N Y). 2016;11:88-96. (Original DOI: 10.1177/1558944715614839) In the above-referenced article, the authors' first names and surnames were incorrectly listed. The corrected author names are presented below: Epameinondas Kostopoulos, Christos Agiannidis, Petros Konofaos, Avraam Dounavis, Othon Papadopoulos, and Vincent Casoli.

Planning digital artery perforators using color Doppler ultrasonography: A preliminary report

Digital artery perforator (DAP) flaps have been applied for the coverage of finger soft tissue defects. Although an advantage of this method is that there is no scarification of the digital arteries, it is difficult to identify the location of the perforators during intraoperative elevation of the DAP flap. In this study, anatomically reliable locations of DAPs were confirmed using color Doppler ultrasonography (US) in healthy volunteers. A successful case using an adiposal-only DAP flap for the coverage of a released digital nerve using preoperative DAP mapping with color Doppler US is also described. A total of 40 digital arteries in 20 fingers of the right hands of five healthy volunteers (mean age: 32.2 years old) were evaluated. The DAPs were identified using color flow imaging based on the beat of the digital artery in the short axial view. In total, 133 perforators were detected, 76 (an average of 3.8 per finger) arising from the radial digital artery and 57 (an average of 2.9 per finger) arising from ulnar digital artery. Sixty-three perforators (an average of 3.2 per finger) in the middle phalanges and 70 (an average of 3.5 per finger) in the proximal phalanges were found. Overall, an average of 1.7 perforators from each digital artery was detected in the proximal or middle phalanges. Moreover, at least one DAP per phalanx was reliably confirmed using color Doppler US. Preoperative knowledge of DAP mapping could make elevating the DAP flap easier and safer.

Predictable Pattern Digital Artery Perforator Flap: An Alternative Concept in Digital Reconstruction.

The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutano-tendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest. From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function. Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient. Authors introduced the concept of a "predictable pattern" in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option.

Digital Artery Perforator Flaps

Digital Artery Perforator Flaps