Digital Flap Research Articles

The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes

Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes. Levels of Evidence: Level V, expert opinion.

Semi-occlusive dressing versus surgery in fingertip injuries: A randomized controlled trial

ObjectivesNo gold-standard treatment has been established for the management of distal digital amputation in Ishikawa zones II and III. The objective of this study was to compare the results of management of fingertip amputation by semi-occlusive dressing versus surgery. The principal hypothesis was that a semi-occlusive dressing results in better recovery of sensory function than a digital flap. MethodsWe conducted a prospective, randomized, multicenter study of 44 patients: 23 managed conservatively with semi-occlusive dressing, and 21 surgically with digital flap. ResultsMean follow-up was 12 months. Mean healing time was 4.9 weeks in the semi-occlusive dressing group and 3.6 weeks in the surgery group. There was no significant difference between groups for sensory recovery of fine touch (p = 0.198) or 2-point discrimination (p = 0.961). No infections were reported in either group. Hook-nail deformity was more frequent in the semi-occlusive dressing group, particularly in case of amputation in zone III. ConclusionsSemi-occlusive dressing enabled satisfactory healing and sensitivity recovery without increasing the risk of infection. However, in zone III amputation, we advocate surgical treatment with a digital flap, due to poor trophicity and the frequency of hook-nail deformity seen with conservative management. Level of evidenceII.

Ulnar lateral digital flap for Dupuytren’s disease of the fifth finger, a technique not be forgotten

Dupuytren's disease is a common condition in hand surgery. The fifth finger is frequently affected, pre- senting the highest recurrence rate after surgical treatment. The ulnar lateral-digital flap is used when a skin defect prevents direct closure after fasciectomy of the fifth finger at the level of the MP joint. Our case series comprises of 11 patients undergoing this procedure. Their mean preoperative extension deficit was 52° at the MP joint and 43° at the PIP joint. Full extension of the MP joint and a mean of 8° extension deficit at the PIP joint was achieved with surgery. All patients maintained full extension at the MP joint, with a follow-up of 1 to 3 years. Minor complications were reported. The ulnar lateral digital flap is a simple and reliable alternative when surgically treating Dupuytren's disease of the fifth finger.

Primary closure using a perforator flap-based technique for the treatment of Dupuytren's contracture

We aim to present a perforator flap-based technique that is useful in the resection and reconstruction of the palmar fascia for the treatment of Dupuytren's contracture with primary closure. A curve incision through the palmar skin radial to the hypothenar area was made. The ulnar side of the palmar skin and the subcutaneous fat was raised to the ulnar side, exposing the palmar fascia. The ulnar palmar digital artery extending from the superficial palmar arch curves distally towards the little finger at a point perpendicular to the fourth interdigital space with parting branches into the subcutaneous fat radial of the flap was carefully identified and preserved, and the Dupuytren's cords were excised. Depending on contracture involvement, additional incision extending from the arc of the palmar incision to the proximal interphalangeal joint is made to raise the digital flap similar to that of the palmar incision. The perforator flap was raised along the hypothenar region in 53 hands of 48 patients, nine women and 39 men, and their age at the time of surgery averaged 56 years. Two patients complained of paresthesia in the ring and little fingers after surgery in 2015, and the symptom had disappeared without further intervention before the latest follow-up in 2017. There was no incidence of skin necrosis, delayed healing, and no recurrence within the follow-up period. This perforator flap-based technique is technically reliable and straightforward with better exposure and easier removal of all the diseased fascia, making it possible for primary healing without skin necrosis and acceptable for the treatment of patients at all stages of the disease.

Reconstruction of thumb defect by transplanting second toe combined with hallucis flap: 9 cases report

Objective To introduce the method for reconstruction of thumb defect by transplanting free flap of second toe combined with the hallucis flap. Methods From June, 2012 to February, 2017, a total of 9 cases of thumb defect were treated. The average age of these 9 patients was 26 years. The plane of thumb defect was class II area A to class III area A. According to the condition of thumb defect, designed the incision on the hallux and the second toe of the contralateral foot, and cut the 2nd digit and big-toe nail flap with a common arterial trunk. The nail of hallucis flap was rotated 90 degree and connected to the distal end of the 2nd toe. The hallucis flap covered the narrow neck of the 2nd toe. Thus, the circumference of the reconstructed finger and the length of the toenail were increased. Regular followed-up was made after operation. Results All 9 transplantation flaps survived, and donor sites healed primarily. Postoperative followed-up period ranged from 4 to 12 (averge,7) months. All the reconstructed thumbs survived and donor toes were in satisfactory appearances. According to the Functional Assessment Criteria of the Upper Limb Formulated by the Hand Surgery Society of Chinese Medical Association, the outcomes were graded as excellent in 6 cases and good in 3 cases. All the patients were able to manage their daily activities independently. Donor toe injury was small, and their shape and function was good. Conclusion Free flap of second toe combined with hallucis can effectively improve the appearance of the reconstructed thumb. The appearance of the reconstructed thumb is symmetrical, beautiful, and the function is good. Key words: Thumb reconstruction; Second toe; Hallucis flap; Tissue transplantation; Thumb defect

The use of CTA combined augmented reality navigation in free anterolateral thigh perforator flap for tongue reconstruction: 9 cases report

Objective To explore the value of CTA combined augmented reality(AR) navigation in tongue reconstruction with free anterolateral thigh perforator (ALTP) flaps. Methods From December, 2016 to December, 2018, 9 cases of tongue cancer patients were treated with lingual reconstruction with the free ALTP flap. The dominant perforator was selected according to CTA before operation. The origin, course, locations at the level passing through the fascia lata of the perforators and digital flaps were located and marked under the guidance of AR navigation technology. The flaps area were 6 cm×8 cm-8 cm×12 cm, and the donor sites were closed directly. The effect of the AR navigation was explored intraoperatively. The function of reconstructed tongue and donor site were followed-up 3 to 6 months post-operatively. Results All navigation-positioned perforators were confirmed by AR preoperatively. Intraoperative exploration showed that the perforators were accurately located. All flaps survived, and no vascular crisis occurred. The donor sites healed primarily with linear scars. The tongue was plump, and the function of voice and swallowing were favorable. Conclusion CTA combined AR navigation has the advantages of accurate location, easy to use and low cost in tongue reconstruction with free ALTP flaps. It is a worthy method to be popularized. Key words: Anterolateral thigh perforator flap; Tongue reconstruction; Augmented reality technology; CT angiography; Microsurgical technique

Clinical application of Reading man flap for repair of the wound of donor site at the dorsum of the finger

Objective To introduce the surgical technique and clinical efficacy of Reading man flap for repair of the wound of donor site at the dorsum of the finger. Methods From February 2016 to August 2018, 9 cases (9 fingers) of fingertip defects were treated with reverse dorsal digital island flap of the same finger. The donor site of dorsal digital flaps was repaired with Reading man flap. After repair of fingertip defects, the defect area of dorsal digital donor site ranged from 2.0 cm×1.3 cm to 2.5 cm×1.6 cm. Results All the flaps survived uneventfully. The average hospitalization time was 10 days. The follow-up time was 3 to 9 months. The texture, color, plumpness and elasticity of the dorsal digital donor site were good. No tendon adhesion, interphalangeal joint and metacarpophalangeal joint stiffness occurred. All the patients were satisfied with the appearance and function of the injured fingers. Conclusion The repair of the dorsal digital donor site with Reading man flap takes into account both appearance and durability, which is beneficial to the early rehabilitation of injured finger and less damage to donor site. The method of operation is safe and simple. It is an improvement on the repair of the donor site of the reverse dorsal digital island flap of the same finger. Key words: Finger injuries; Surgical flaps; Reading man flap; Flap donor site

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

Clinical application of web-space artery perforator and dorsal branch of the proper digital artery network flap for repair of finger pulp defects

Objective To evaluate the clinical efficacy of web-space artery perforator and dorsal branch of the proper digital artery network flap in the treatment of finger pulp defects. Methods From January 2015 to May 2017, 30 cases (36 fingers) of finger pulp defects were treated by web-space artery perforator and dorsal branch of the proper digital artery network flap. The nerve stump and dorsal digital nerve were sutured to reconstruct the flap sensation. The area of finger pulp defects ranged from 1.1 cm×0.8 cm to 2.3 cm×4.0 cm. The donor site was sutured directly or covered with skin graft. Results After the operation, tension vesicles appeared at the distal end of the flap in 3 cases which achieved secondary healing after dressing changes and flaps edge bleeding. Partial skin flap necrosis and scab occurred in 1 case that achieved healing after the decrustation. The rest of the flaps achieved primary healing. All the patients were follow-up for 3 to 24 months with an average of 16.8 months. The texture of skin flap was soft with satisfactory appearance. The skin flap recovered pain and temperature sensation 2 months after operation. And 3 months after the operation, the tactile sensation was restored. The two-point discrimination was recovered at 6 months after operation, with an average of 7.5 mm and an average of 6.2 mm at 12 months postoperatively. The total active movement (TAM) achieved 105° to 230° with an average of 204.6°. The results were graded as excellent in 22 fingers, good in 11 fingers, fair in 2 fingers, and poor in 1 finger with an excellent and good rate of 91.7%. Conclusion Compared with the traditional digital artery island flap, the island flap of web-space artery perforator and dorsal branch of the proper digital artery is used to repair the defects of the finger pulp, lengthening the length of the pedicle and enlarging the indication of the operation. The operation is simple and safe. It is a better method to repair the defect of the finger pulp. Key words: Finger injuries; Surgical flaps; Web-space artery perforator; Dorsal branch of the proper digital artery

Prise en charge des traumatismes de doigt de bague. À propos de 16 cas

The “ring finger” avulsion, is the removal of a finger by a ring or by a similar mechanism. This accident is frequent. The finger is torn by the ring which is accidentally retained by a fixed point while the subject is driven by the weight of his body. Our aim is to discuss the different therapeutic alternatives and to emphasize the importance of multidisciplinary care. This study involved 16 patients who presented a ring finger between the years 1997 and 2016. For each patient, we studied the epidemiological data, avulsion according to the Carroll Larrou classification and the surgical techniques implemented as well as an analysis of the clinical and functional results and the psychological repercussions. Non-military patients were excluded. Several flaps have been used. We basically used distant flaps. MacGregor's inguinal flap was the flap of choice. Among the digital flaps, we used the flag flap and the intermetacarpal flap. The pulling of a ring on a finger causes an avulsion phenomenon of the tissues contrary to the section of a finger by a sharp object. We have adopted the one of Caroll Larrou. Therapeutic attitudes are multiple (Dubert et al., 2000). Skin coverage is essential to preserve the noble tissue of necrosis. Several flaps have been described in the literature. With the advent of microsurgery, several teams have attempted the reimplantation of ring fingers. Amputation is sometimes preferred when the stage of the injury is advanced, mainly for aesthetic and psychological reasons. The injuries of the hand have significant psychological repercussions because of the trauma itself, resulting functional loss in addition to changes in self-image. Based on our series and on the review of the literature, we highlight the seriousness of the injuries. The prognosis is bleak despite the progress of microsurgery and the need to promote the means of prevention. It is also important to emphasize the importance of multidisciplinary and urgent management in order to improve the functional prognosis and limit the psychological repercussions.

Free Lateral Digital Flap for Reconstruction of the Fingers.

The region between the proximal interphalangeal (PIP) and the metacarpophalangeal (MP) creases has greater laxity than other regions in the fingers, allowing for primary closure of the donor site. We postulated if we could consistently locate perforators from the region between the PIP and the MP crease on the radial side of the middle and ring fingers, on which a scar would be less conspicuous than one on the radial side of the index finger, these regions would be ideal donor sites for digital reconstruction using very small flaps. In 20 fingers (10 middle fingers and 10 ring fingers) from 5 volunteers, perforators from the radial proper digital artery were visualized between the PIP and the MP creases using ultrasonography. Based on this information, and to evaluate its feasibility, a free lateral digital flap was used for reconstruction of small digital defects in 3 cases. Of the 20 fingers, 19 had at least 1 digital artery perforator (DAP) arising from the radial proper digital artery between the PIP and MP creases. The average distance from the PIP crease to the DAP was 9.0 mm. The average diameter of the DAP was 0.37 mm. In all clinical cases, flaps survived completely with pleasing cosmesis. There were no donor site complications. With their consistent anatomy and relatively low donor site morbidity, free lateral digital flaps from the radial side of the middle or ring fingers may be a reliable option for reconstruction of the volar surface of the digits.

Management of finger deep burns: The interest of local flaps

IntroductionThe management of finger deep burns is still problematic for the surgeon. Due to the fineness and the thickness of the subcutaneous tissue, after excision there is an important risk of exposure of the underlying tissue like bone, nerve or tendons.Local flaps (random pattern flap and pedicle flap) allowed ensuring a good quality covering with a tissue with many advantages (good thickness, sensitivity). On the contrary of all other techniques, flaps can be used independently from the vascular quality of the wound bed. Despite those advantages, the literature is poor to report the experience of flap in the management of finger deep burn. Material and methodsWe report our experience in the use of such technique with a series of 49 flaps. The cohort consisted of 34 patients (22 men and 12 women) who were treated in our unit between 2003 and 2012. ResultsOf the 49 flaps made, 71,4% were homodactyl flaps. 22,5% were heterodactyl flaps and 6,1% were intermetacarpian (second space) flaps. The rate of success was 87,8%. We reviewed 16 patients out of 34 patients operated, 20 of the 49 flaps performed (40,8%). The patients were reviewed by an independent surgeon. The average follow-up at this consultation was 4,25±2,46 years. The monofilament test was positive for 17 flaps (85% of cases). For the Weber’s test, we found a normal perception threshold for 11 flaps (55%), with an average test at 2,8mm (2–4mm). Normal motricity was found at the donor site in 14 of the 16 patients evaluated for 18 of the 20 revised flaps (90% of cases). In terms of cosmetic result, the average overall score obtained at the patient’s own evaluation was 0.85. That obtained by the evaluator was equal to 0.55, with no significant difference (scale range from 0 best results to 5 worse results). DiscussionHand and finger burns are frequent and benefit from rapid, high-quality coverage, enabling early mobilization to combat secondary stiffness problems. The high success rate of our series, as well as the quality of the functional and cosmetic results obtained, demonstrate the reliability and the interest of the digital flaps.

De-epithelialized dorsal digital turnover flap for coverage of volar digital lesions: a modified technique

Volar digital injuries represent a challenge to hand surgeons. Anatomical studies demonstrate the existence of dorsal digital branches of the ulnar and radial arteries at predictable and regular distances from the PIP joint, bilaterally. Moreover, as there are also small veins that accompany the arterial branches, we designed a novel de-epithelialized dorsal finger turnover flap, which can be performed on the ulnar and radial sides of fingers where it is important to maintain the paratenon to support the dorsal skin flap. A 21-year-old female presented with traumatic injury to the middle phalanx of the third finger associated with loss of substance and damage to the flexor tendons in zone II. The dorsal part of the finger was used to provide coverage for a volar injury. There was no scar retraction or functional limitation of the reconstructed finger. This novel, de-epithelialized dorsal finger turnover flap can be safely used for coverage of volar finger lesions, due to a reliable and well-described arterial supply, with no skin necrosis of the donor site, post-surgical infection, or scarring complications. Level of Evidence: Level V, therapeutic study.

Sensory reconstruction in different regions of the digits: A review of 151 cases

BackgroundSoft tissue defects of the digits are very common in hand trauma and can result in functional disability. The purpose of the study is to introduce the use of several modified and traditional sensate flaps to reconstruct different regions of the digits and to evaluate the efficacy of these techniques. MethodsA retrospective study was conducted with 151 patients who had soft tissue defects of the digits treated with the sensate flaps from February 2005 to March 2014. Based on different regions of the soft tissue defects, the patients in the study were divided into four groups [1]: thumb group treated with the dual-innervated and traditional kite flaps [2]; distal finger group treated with the single- and dual-innervated dorsal digital flaps [3]; proximal finger group treated with the heterodigital neurocutaneous island flap; and [4] awkward region group treated with the Litter flap. The main outcomes were static 2PD and Semmes-Weinstein monofilament scores of the flap, pain and patient satisfaction. ResultsSignificant difference was found between dual-innervated and traditional kite flaps, and between single- and dual-innervated dorsal digital flaps in static 2PD, pain and patient satisfaction (P<0.05). Double nerve repairs presented better discriminatory sensation on the flap, lower incidence of pain in the injured digit and larger satisfaction degree than single nerve repair. ConclusionsCompared to single-innervated flap, dual-innervated flap exhibited better sensory recovery and lower pain incidence. Being an additional treatment option, Littler flap may be better choice for sensory coverage in some specific situations including border injuries.

A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation.

Revision amputation is often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact is poorly understood. The authors performed a systematic review to evaluate outcomes of revision amputation and amputation wound coverage techniques. The authors searched all available English literature in the PubMed and Embase databases for articles reporting outcomes of nonreplantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes, and complications. A total of 1659 articles were screened, yielding 43 studies for review. Mean static two-point discrimination was 5.0 ± 1.5 mm (n = 23 studies) overall, 6.1 ± 2.4 mm after local flap procedures, and 3.8 ± 0.4 mm after revision amputation. Mean total active motion was 93 ± 8 percent of normal (n = 6 studies) overall. It was 90 ± 9 percent of normal after local flap procedures and 95 percent of normal after revision amputation. Seventy-seven percent of patients reported cold intolerance after revision amputation. Ninety-one percent of patients (217 of 238) reported "satisfactory" or "good/excellent" ratings regardless of treatment. Revision amputation and conservative treatments result in better static two-point discrimination outcomes compared with local flaps. All techniques preserve total active motion, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report "satisfactory," "good," or "excellent" ratings in appearance and quality of life with all nonreplantation techniques.

Digital Fillet Flaps: A Systematic Review.

Digital fillet flaps have a consistent vascular supply and provide durable soft-tissue coverage. Despite their readily available nature, their use in the foot remains limited. This systematic review was undertaken to determine the size defect that could be covered, the potential postoperative complications, and the durability of a digital fillet flap. Studies were eligible for inclusion if they involved use of the entire digit for soft-tissue coverage of defects of any etiology, reported complications, and had any length of follow-up time. A total of 9 studies met all the inclusion criteria, for a total of 34 patients with a combined mean age of 47.1 years and a combined mean follow-up time of 9.3 months. Complications consisted of continued infection and partial or total necrosis of the flap. Digital fillet flaps were able to cover defects up to a combined mean size of 15.6 cm2. Coverage was found to be best for forefoot ulcerations. The flaps had limited donor site morbidity and provided full coverage of exposed vital and osseous structures that was able to withstand forces applied during weight bearing, The procedure is simple and straightforward, reducing operating time and the need for more complex soft-tissue reconstructive procedures. Therapeutic, Level IV: Systematic review.

Bilaterally innervated dorsal digital flap for sensory reconstruction of digits

BackgroundProviding sensory coverage in digits continues to be a challenging problem. This study reports the sensory reconstruction of digits with bilaterally innervated dorsal digital flaps and compares the results between dual- and single-innervated flaps. MethodsOver 7 years, a retrospective study was conducted with 73 patients who had soft-tissue defect of the digit treated with the bilaterally innervated dorsal digital flap. There were 73 soft-tissue defects in 73 digits. The size of the defects ranged from 1.8 to 2.7cm in length (mean, 2.2cm) and from 1.6 to 2.2cm in width (mean, 1.9cm). The bilateral dorsal branches of the digital nerves were attached with the flap for the sensory reconstruction of digits. Reconstructive techniques included the cross-finger flap in 35 cases, the dorsal digital island flap in 24 cases, and the dorsal digital free flap in 14 cases. To objectively evaluate the efficacy of the bilaterally innervated flaps, we selected a comparison group that included 42 patients treated with the single-innervated flap. ResultsA significant difference was found between the dual- and single-innervated flaps in two-point discrimination, pain, Tinel's sign, and patient satisfaction results. By comparison, the dual-innervated flap presented better discriminatory sensation on the flap, lower incidence of pain and Tinel's sign, and a larger degree of satisfaction than the single-innervated flap. Of the dual-innervated flap group, the mean joint motion of the donor finger was similar to that of the opposite side. ConclusionsThe bilaterally innervated dorsal digital flap is a reliable alternative for the sensory reconstruction of digits. Performing double neurorrhaphies can improve flap sensation and reduce digital neuroma incidence when reconstructing a soft-tissue defect associated with both transected digital nerves.

Use of the Dorsal Digital Sensate Free Flap for Reconstruction of Volar Soft Tissue Defect of Digits

Sensate cross-finger flaps and homodigital and heterodigital island flaps can usually be used for sensory reconstruction in the volar aspect of the digit. However, when the donor areas are damaged by concomitant injuries, these flaps are not available. The free dorsal digital flap, including both dorsal branches of the proper digital nerves, can be used as an alternative to resolve this problem. The flap was used in 16 patients with soft tissue defects on the volar aspect of the digits. For comparison, we collected a consecutive series of 31 patients with similar defects treated using a cross-finger flap including one branch. At final follow-up, the static 2PD of 2-branch flap is superior to 1-branch flap. The dorsal digital sensate free flap can be used as an alternative for the reconstruction of volar soft tissue defect of the digits. Sufficient sensory recovery can be achieved using this technique.

Dorsal digital advancement flaps vascularized with digital arteries for repair of finger pulp defect

Objective To investigate the effect of dorsal digital island advancement flaps accompanied with digital arteries in reconstruction of finger pulp defect.Methods The study enrolled 36 cases (43 fingers) of pulp soft tissue defect treated from October 2007 to July 2011.There were 25 males (30 fingers) and 1l females(13 fingers),at age of 12-62 years (mean 34.5 years).Causes of injury included crushing in 19 cases (16 fingers),squeezing in 13 (16 fingers) and cutting in 4 (5 fingers).The fingers involved were the index (11),the middle (18),the ring (9),and the little (5).All wounds revealed the exposed bone with defect area ranging from 1.2 cm × 1.0 cm to 2.6 cm × 2.0 cm.Dorsal digital island flaps accompanied with digital artery were used for finger reconstruction and sensation was restored by anastomosing to dorsal branch of digital nerve.Donor sites were closed using skin grafts.Results All flaps survived.Thirty-three cases (39 fingers) were followed up for 5-26 months (mean 14.5 months).The flaps revealed satisfactory appearance,soft texture and good elasticity.The injured fingers were pain-free.Two point discrimination was 5-8 mm (mean 6.7 mm).According to the upper limb function criteria formulated by Hand Surgery Branch of Chinese Medical Association,the results were excellent in 24 fingers,good in 13 fingers,and fair in 2 fingers,with the excellence rate of 95％.Conclusion Dorsal digital advancement island flap vascularized with digital artery is relatively the best for finger pulp coverage,for the procedure is easy and safe,with satisfactory result. Key words: Finger injuries; Surgical flaps; Reconstruction

Le lambeau de rotation latéro-digital de Razemon dans les formes graves de la maladie de Dupuytren du cinquième rayon

In Dupuytren's disease, correction of severe contracture deformities and excision of dermal lesions are often responsible for palmar skin defects. This study aimed to assess the results of the lateral digital flap described by Razemon. Thirty-seven patients were analysed retrospectively for functional and trophic results. Twelve months of follow-up were at least required. The lack of extension was appreciated through Thomine's coefficient. Subjective patient's opinion was noted about function of fifth finger and hand. The flap trophicity was evaluated through softness, coverage quality and esthetic aspect. In the preoperative period, the average lack of extension was 105°; 89% of the patients were ranked as stages 3 or 4 of Tubiana's classification. At the 12th month, the average Thomine's coefficient was 0.74; 70% of the patients were very satisfied. Two patients exhibited some lack of suppleness and seven a dyschromic scars. The lateral digital rotation flap is a quite simple surgical procedure. It allows satisfactory results corresponding to functional and trophic coverage in severe Dupuytren's contracture involving the fifth finger.