Donor Finger Research Articles

Thumb Tip Defect Reconstruction Using Neurovascular Island Pedicle Flap Obtained From Long Finger.

Thumb tip reconstruction has been a very challenging issue for hand surgeons. Varieties of reconstructive options have been described or modified to obtain satisfactory sensory recovery. However, none has yielded entirely satisfactory results. This study reports a retrospective review of clinical data records of patients treated with a neurovascular island pedicle flap obtained from the medial aspect of the long finger. We enrolled 15 patients (9 men and 6 women), who received neurovascular island pedicle flaps for thumb tip amputations between December 2011 and December 2015. The average size of the flap was 2.8×2.2cm(2) (range 2.5×1.8cm(2) to 3.5×2.5cm(2)). At the final follow-up visits, static two-point discrimination, visual analogue scale, Michigan hand outcome questionnaire and return-to-work time were used to evaluate surgical outcomes. All flaps survived well. The follow-up period was 18months. The mean static 2PD values at the reconstructed thumb tip and donor finger pulp (medial side) were 5.3mm (range 4-8mm) and 3.2mm (range 3-4mm), respectively. The average VAS scores for the aesthetic appearance of the donor site and recipient site were 9.1 (range 8-10) and 9.0 (range 8-9.5), respectively. The average Michigan Hand Outcome Questionnaire (MHOQ) score for hand function (reconstructed hand) was 8.2 (range 6-16). The average RTW time was 8.4weeks (range 7-12weeks). Neurovascular island pedicle flap obtained from the medial aspect of long finger is a very reliable alternative technique for thumb tip defect reconstruction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Predonation finger lancet punctures: a potential risk factorfor interdonor pathogen transmission in the blooddonor clinic.

Point-of-care testing using capillary blood from a finger prick is widely used for predonation haemoglobin testing of blood donors. It is common practice to cover the finger prick with a cotton swab and to instruct the donor to press for few minutes. The finger prick can cause blood contamination of surfaces in contact with the lanced finger, especially door handles, risking infectious disease transmission, particularly if another person touching the contaminated door handle also has a punctured fingertip. First, we investigated contamination by blood (benzidine assay) of the door handles of our blood donor clinic, taking 175 samples 3h after opening of the donation centre (baseline). We then introduced band-aids to cover the finger prick and started an information campaign using educational flyers to sensitize blood donors and staff to this problem (period-1). Thereafter, the staff was instructed to use the non-dominant hand for blood sampling and mandated to replace any discarded band-aids immediately (period-2). At baseline, 82% of the nurse room door handles showed contamination with blood. This decreased somewhat (10-40%) after period-1, but only after immediate mandatory band-aid replacement on any donor finger without a band-aid (period-2), no further blood contaminations were detected. Blood contamination of shared surfaces can occur after finger prick for capillary blood sampling. Application of a band-aid and use of the non-dominant hand for fingertip incision are easy to apply and effective in reducing this iatrogenic health hazard.

Heterodigital flaps for severe pulp defects

Heterodigital flaps for severe pulp defects

Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap

Providing soft-tissue coverage for a large defect in the single finger presents marked functional and aesthetic challenges. This article describes the reconstruction of such injuries using a modified cross-finger flap, and it reports the results of the use of the flap. Over 5 years, a retrospective study was conducted with 22 patients who had a large defect in the single finger. The mean size of soft-tissue defects was 4.3±0.4cm in length and 1.8±0.4cm in width. The defects were reconstructed with a modified cross-finger flap. Full-flap survival was achieved in 20 fingers. Partial distal-flap necrosis occurred in two fingers, which healed without surgical intervention. We collected the data of the sensory restoration in 20 flaps where sensory return was considered important. Based on the modified American Society for Surgery of the Hand guidelines for the stratification of a two-point discrimination (2PD), 17 (85%) flaps achieved excellent and good results and only three (15%) flaps obtained fair result. No significant difference was found in joint motion between the donor finger and the contralateral side. According to the Michigan Hand Outcomes Questionnaire, 11 patients were satisfied, nine were somewhat satisfied and two were neither satisfied nor dissatisfied with the functional recovery of the reconstructed finger. The modified cross-finger flap is versatile and useful for the coverage of the relatively large defect in the single finger, especially when sensory reconstruction is needed. Therapeutic IV.

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.

Direct and reversed dorsal digital island flaps: A review of 65 cases

BackgroundReconstruction of soft tissue defects in fingers continues to be a challenging problem. The purpose of this study is to report the reconstruction of small-to-moderate defects of fingers with dorsal digital island flap (DDIF) and to evaluate the efficacy of use of the flap. MethodsOver last six years, a retrospective study was conducted with 65 patients who had soft tissue defects of fingers treated with the DDIF. Sixty-nine soft-tissue defects were found in 69 fingers in 65 patients. Based on the flow direction of blood supply, the patients were divided into two groups: the direct (n=35) and reversed (n=30) DDIF groups. In addition, based on the different donor sites, the direct DDIF group was divided into two subgroups: the proximal phalangeal direct DDIF subgroup (n=16) and the extended pedicle direct DDIF subgroup (n=19). The main outcomes were static 2-point discrimination and Semmes–Weinstein monofilament scores of flap and joint motion. ResultsAt the final follow-up, the mean static two-point discrimination of the flaps was 9.7mm (range, 8 to 12mm) in the proximal phalangeal direct DDIF subgroup and 8.3mm (range, 7 to 11mm) in the extended pedicle direct DDIF subgroup, with a significant difference (p=0.005). In the direct DDIF group, there was no significant difference in total active motion between the donor fingers and the opposite sides. In the reversed DDIF group, the mean total active motion of the donor fingers was 170° and the data of the opposite sides was 181°, with a significant difference (p=0.024). Maximum amplitude losses of 15° were seen in 12% of patients in the distal interphalangeal joint. ConclusionsThe DDIF is reliable and technically easy for reconstructing small-to-moderate defects of fingers. The extended pedicle direct DDIF may be an optional solution when sensory reconstruction is needed.

Direct and reversed dorsal digito-metacarpal flaps: A review of 24 cases

The common source for reconstruction of soft tissue defects of the fingers is either the same finger or the adjacent finger. However, when the donor areas are damaged by concomitant injuries, these options are not available. The purpose of this study was to report on reconstruction of these complex digital injuries using the dorsal digito-metacarpal flaps (DDMFs) and to evaluate the efficacy of this technique. A retrospective study was conducted with 24 patients who had their fingers reconstructed using the DDMF from April 2009 to September 2011. The patients were divided into two groups based on the flow direction of the blood supply. Among them, nine patients had their fingers reconstructed with the direct DDMFs. Fifteen patients underwent tissue reconstruction in the distal phalanx with the reversed DDMFs. At a mean follow-up of 20 months (range, 18-24 months), the mean static two-point discrimination on the flaps was 8.3 mm (range, 7-10 mm) in the direct DDMF group and 10.4 mm (range, 9-14 mm) in the reversed DDMF group, with a significant difference (P=0.001). The range of motion of the donor fingers was similar to that of the opposite hands. According to the Michigan Hand Outcomes Questionnaire, 11 patients were very satisfied, 10 were satisfied and three were neither satisfied nor dissatisfied with functional recovery of the reconstructed finger. The DDMF is an additional option for coverage of a soft tissue defect of the finger when the commonly used local and regional flaps are not feasible. NCT 01927003. Therapeutic/IV.

Reconstruction of a neurocutaneous defect of the proximal phalanx with a heterodigital arterialised nerve pedicle flap

BackgroundComplex digital injuries involving soft-tissue loss and digital nerve defect pose a challenging problem for hand surgeons. The purpose of this study was to evaluate the efficacy of transferring the heterodigital arterialised nerve pedicle flap for reconstructing the digital neurocutaneous defects and to compare the results with those of transferring the cross-finger flap and secondary nerve grafting. MethodsFrom March 2008 to September 2011, the nerve pedicle flap was used in 12 patients who had a combination of soft-tissue and digital nerve defects. The injured fingers included four index, four long, three ring and one little finger. The mean size of the soft-tissue losses was 2.4×1.9cm (range, 2.3×1.3 to 3.2×2.0cm). The mean flap size was 2.6×2.1cm (range, 2.5×1.5 to 3.4×2.2cm). The length of the nerve defects ranged from 1.5 to 3.8cm (mean, 2.8cm). The nerve defect was reconstructed with transfer of the digital nerve dorsal branch. For comparison, we collected a series of 24 patients with similar defects treated with the cross-finger flap and secondary free nerve grafting. ResultsSignificant differences were found between the two groups in static two-point discrimination (p<.01) and pain (p=.03) in the reconstructed finger. In comparison, the study group presented better discriminatory sensation on the finger pulp and lower incidence of pain sensibility in the injured finger. There was no significant difference in cold intolerance and Semmes–Weinstein monofilament. In the study group, the total active motion of the donor fingers was similar to that of the opposite hands. ConclusionsThe heterodigital arterialised nerve pedicle flap is useful and reliable for reconstructing the neurocutaneous defects in the proximal phalanx. Comparable sensory recovery and lower pain incidence can be achieved using our nerve pedicle flap instead of conventional nerve grafting. Type of study/level of evidenceTherapeutic II.

Treatment of Distal Fingertip Degloving Injuries Using a Cross-Finger Flap Based on the Dorsal Branch of the Proper Digital Artery at the Middle Phalanx

This study reports our experience with reconstruction of distal fingertip degloving injuries using a single cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. From January 2009 to October 2011, 18 patients (18 fingers) presented with distal fingertip degloving injuries and were treated with this technique. The mean size of the soft tissue defects was 4.5 cm in length and 2.0 cm in width. The mean size of the cross-finger flaps was 4.7 × 2.1 cm. In the series, all flaps survived completely. No complication was reported, and no further flap debunking procedure was required. At the mean follow-up period of 20.5 months (range, 12-48 mo), the mean static two-point discrimination was 6.3 mm (range, 5-9 mm) of the reconstructed finger pulp. The total range of active motion of the proximal and the distal interphalangeal joints of the donor fingers were 105 and 77.4 degrees, respectively. The cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx is a reliable and simple method in reconstruction of distal degloving injuries of the finger.

Reconstruction of a soft tissue defect in the finger using the heterodigital neurocutaneous island flap

BackgroundThis article describes reconstruction of a soft tissue defect in the finger using the heterodigital neurocutaneous island flap and reports the results of the use of the flap. MethodsFrom February of 2008 to March of 2011, the neurocutaneous island flap was used in 12 patients with soft tissue defects in the middle phalanx or the proximal interphalangeal joint, or both. The injured fingers included 4 index, 3 middle, 3 ring and 2 little fingers. The donor fingers included 7 middle fingers and 5 ring fingers. The mean size of soft tissue defects and the flaps was 2.4cm×1.8cm and 2.7cm×2.0cm, respectively. The mean pedicle length was 2.8cm. ResultsFull flap survival was achieved in 11 cases. Partial distal flap necrosis was noted in one case, which healed without surgical intervention. At a mean follow-up of 22 months, the mean static 2-point discrimination and Semmes-Weinstein monofilament scores on the flap were 8.3mm and 3.94, respectively. Based on the modified American Society for Surgery of the Hand guidelines for stratification of 2-point discrimination, 10 (83%) of 12 flaps achieved good results. According to the Michigan Hand Outcomes Questionnaire, 5 patients were strongly satisfied and 7 were satisfied with functional recovery of the reconstructed finger. ConclusionsThe neurocutaneous island flap of the dorsal branch of the digital nerve is useful, reliable, and technically easy for reconstructing a defect in the adjacent fingers, especially when sensory reconstruction is needed.

Cross Finger Dorsal Adipofascial Flap-is It a Aesthetically Better Variant?

The cross finger flap is a useful option for coverage of finger defects. The Adipofascial flap, a variant has been a good option being aesthetically more acceptable. Since hand is generally exposed part, we tried to find out the aesthetic value of the adipofascial cross finger flap. We operated on 15 patients who had complex defects on the fingers, who needed a flap cover and accepted for the adipofascial variant. We asked for ten independent non-medical literate persons to rate the photos of donor site and recipient site of these patients. We also requested the same ten people to rate the photos of similar, paired defects of the standard flap, which were obtained from the department archive. All the flaps survived. The mean score for adipofascial flap donor finger was 3.859 and it was 3.6 for the donor finger of the standard cross finger flap. The Cornbach's alpha of the interpretors was more than 0.7 for donor fingers and more than 0.9 for recipient fingers. The ICC was 0.767 foradipofascial donor finger and more than 0.9 for recipient fingers of both flaps. Adipofascial cross finger flap may be an aesthetically better flap.

Extensor indicis proprius opponensplasty for isolated traumatic low median nerve palsy: A case series

The standard opponensplasty for isolated low median nerve palsy in nonleprosy patients uses the flexor digitorum superficialis of the ring finger. To report the results of extensor indicis proprius (EIP) opponensplasty in 15 consecutive nonleprosy patients with isolated traumatic low median nerve palsy. A retrospective study of the author's cases of EIP opponensplasty for isolated traumatic median nerve palsy over the past 15 years was conducted. The author used the EIP to restore thumb opposition in all cases of isolated median nerve palsies when the following conditions were present: protective sensibility in the median nerve distribution; normal power of EIP; supple hands; and full passive range of opposition with no contracture of the first web space. There were a total of 15 patients with a mean age of 30 years (range 20 to 45 years). They all had traumatic isolated low median nerve palsy with recovery of at least protective sensation and no recovery of opposition. The tendon was harvested just proximal to the extensor expansion, the flexor carpi ulnaris was used as a pulley and the insertion was to the tendon of abductor pollicis brevis. There were no postoperative complications or extension lag of the donor finger. Using previously published criteria, 12 patients experienced excellent results while the remaining three had a good result. In nonleprosy patients with isolated traumatic low median nerve palsy, the results of this transfer are consistent and there is no need to harvest the EIP tendon distal to the extensor expansion because a single insertion to the abductor pollicis brevis is sufficient.

Modified Tajima technique for reconstruction of thumb opposition after median nerve palsy

Objective To introduce the application of extensor digiti minimi tendon transfer(modified Tajima technique)for functional reconstruction of thumb opposition following median nerve palsy.Methods Thumb opponenplasty was done in 11 cases of high median nerve injury with irreversible palsy.Modified Tajima technique was used to transfer the extensor digiti minimi tendon.The proximal band was anchored onto the extensor pollicis longus tendon at the metacarpal neck.The distal band was inserted in the medullary cavity of the proximal phalanx.Results The patients were follow-up for 4 to 38 months with an average of 18.5 months.Thumb opposition was restored in all 11 patients with 100％ success rate.The extension of the donor finger was not affected.Conclusion Modified Tajima method is a simple and reliable method to reconstruct thumb opposition function. Key words: Median nerve; Wounds and injuries; Tendon transfer; Thumb oppositional function

Use of twin dorsal middle phalangeal finger flaps for thumb or index finger reconstruction

Amputation or degloving injuries of the thumb or index finger are highly disabling. We describe the use of twin dorsal middle finger flaps harvested from the dorsal aspects of the middle and ring fingers, and based on one palmar proper digital artery, its venae comitantes, and the dorsal branches of the palmar digital nerves of the middle and ring fingers, respectively. These flaps offer advantages when large soft tissue defects of the thumb or index finger are present. In this study, twin dorsal middle finger flaps were used in nine patients (six thumbs, three index fingers). All flaps completely survived. At the mean follow-up of 20 months, the appearance of the reconstructed thumbs or index fingers was acceptable, the length was maintained, and the mean static 2-point discrimination values were 10 mm in the palmar flap and 13 mm in the dorsal flap of the reconstructed digit. All patients were satisfied with the appearance and mobility of the donor fingers. All but one donor finger showed normal finger pulp sensibility, with a static 2-point discrimination between 3 and 6 mm.

Foucher First Dorsal Metacarpal Artery Flap Versus Littler Heterodigital Neurovascular Flap in Resurfacing Thumb Pulp Loss Defects

Our study aims to illustrate the advantages and disadvantages of Foucher's first dorsal metacarpal artery flap and Littler's heterodigital neurovascular flap in thumb pulp reconstruction, by assessing wound healing of donor and recipient sites, sensibility, and functional outcome of the reconstructed thumb. Fourteen male patients were reconstructed either with Foucher (n = 8) or Littler flap (n = 6). Dissection of Foucher's flap was faster than that of Littler's flap. All Littler flaps survived completely, but we experienced 1 partial Foucher flap necrosis. Thumb motility and stability was optimal in all patients. Wound healing of donor sites was achieved in both groups. Two patients reconstructed with Littler flap developed scar contractures and presented a reduced range of motion of donor finger and first webspace, respectively. Although Littler flap resulted in better sensibility and tactile gnosis of the reconstructed thumb-pulp, Foucher flap ensured negligible donor site morbidity, complete cortical reorientation, and better overall hand function.

Use of a Bilobed Second Dorsal Metacarpal Artery-Based Island Flap for Thumb Replantation

An extensive traumatic defect at the level of the proximal phalanx of the thumb presents difficulty in replantation. We report bilobed second dorsal metacarpal artery-based island flap harvested from both the index and middle fingers for reconstruction of the defect and preservation of the normal thumb length. From March 2004 to October 2008, 15 patients (11 men and 4 women; mean age, 35 y; range, 18 to 55 y) with completely or incompletely amputated thumbs associated with extensive defects in the proximal phalanx had replantation and reconstruction. In all cases, a bilobed second dorsal metacarpal artery-based island flap was used due to the large size of the defect. After flap transfer, anastomoses between the veins of the distal part of the thumb and the flap were performed. At the final follow-up, we assessed the mean active range of motion of the metacarpophalangeal and interphalangeal joints of the thumb and the span of the first web in the thumbs that survived. Active motion of the donor fingers was also assessed. In this series, 13 thumbs survived and 2 failed. All flaps survived completely. At the mean follow-up of 27 months (range, 24 to 29 mo), the mean active motion arcs of metacarpophalangeal and interphalangeal joints were 32° (range, 15° to 45°) and 31° (range, 0° to 47°), respectively. Full active range of motion was observed in all patients in both the metacarpophalangeal and the proximal interphalangeal joints of the donor index and middle fingers. Bilobed second dorsal metacarpal artery-based island flap transfer is a useful and reliable technique for thumb replantation when there is an extensive defect in the proximal phalanx and when a single-digit dorsal metacarpal artery island flap is too small. Therapeutic IV.

Treatment of Thumb Tip Degloving Injury Using the Modified First Dorsal Metacarpal Artery Flap

This study reports repair of a thumb tip degloving injury using the modified first dorsal metacarpal artery (FDMA) flap, including both dorsal branches of the proper digital nerve (DBPDNs). From May 2006 to February 2008, the modified FDMA flap was used in 11 thumbs in 11 patients. All patients suffered a degloving injury to the thumb tip, and 4 had associated bone loss ranging from 1 to 3 mm (mean, 2 mm) in length. The size of the soft tissue defects was 2.6 to 4.6 cm (mean, 3.5 cm) in length and 1.8 to 2.2 cm (mean, 2.0 cm) in width. The flaps ranged in size from 2.7 × 2.2 cm to 4.8 × 2.1 cm (mean, 3.6 × 2.1 cm). The mean pedicle length was 7.2 cm (range, 6.8-7.5 cm). Neurorrhaphy between the DBPDN and the proper digital nerve was performed in both sides in all cases. Patient follow-ups ranged from 26 to 47 months (mean, 32 mo). Sensibility of the reconstructed thumb was evaluated by static 2-point discrimination. The range of motion of the donor fingers was measured. The data were compared to those of the opposite sides. All flaps survived completely. At the final follow-up, the mean values of static 2-point discrimination were 5 mm (range, 4-8 mm) and 6 mm (range, 4-8 mm) on the radial and ulnar sides of the distal portion of the flap, respectively. The mean values of the radial and ulnar distal portions of the flaps reached 75% and 72% of those of the opposite sides. The mean range of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the donor fingers were 73°, 101°, and 70°, respectively. The modified FDMA flap, including both DBPDNs, is useful for restoration of sensation on the thumb tip and maintenance of adequate length of the thumb. Therapeutic IV.

Treatment of a Combination of Volar Soft Tissue and Proper Digital Nerve Defects Using the Dorsal Digital Nerve Island Flap

A combination of volar soft tissue and proper digital nerve (PDN) defects in the middle and proximal phalanges can cause sensory loss of the finger pulp, which results in functional disability. This study reports treatment of these complex soft tissue defects using the dorsal digital nerve island flap (DDNIF) from the adjacent finger. From May 2005 to October 2008, we used the DDNIF in 12 digits in 12 patients who had a combination of volar soft tissue and PDN defects in the middle phalanx, the distal third of the proximal phalanx, or both. The flaps ranged in size from 2.0 × 1.7 to 3.3 × 2.4 cm (mean, 2.8 × 1.9 cm). We reconstructed the PDN defect using the dorsal branch of the PDN graft harvested from the adjacent finger. The average length of the nerve grafts was 2.7 cm (range, 2.0-3.6 cm). Patient follow-up was 10 to 22 months, with a mean of 15 months. We evaluated sensibility of the pulp of the injured finger by moving and static 2-point discrimination. We measured the range of motion of the donor finger and compared the data with those of the opposite side. Hand appearance was assessed using the Michigan Hand Outcomes Questionnaire. We measured cold intolerance of the injured finger using the self-administered Cold Intolerance Severity Score questionnaire. All flaps survived completely. At the final follow-up, the mean values of moving and static 2-point discrimination were 5.4 and 7.2 mm in the pulps of the respective injured fingers. The range of motion of the donor finger was similar to that of the opposite side. The mean appearance score of the hands based on the Michigan Hand Outcomes Questionnaire was 18.5 (range, 17-20). All patients experienced mild finger cold intolerance. The DDNIF can be used to cover the combination of volar soft tissue and PDN defects, restoring sensation in the pulp of the adjacent finger. Therapeutic IV.

Repair of finger pulp defect using free digital artery dorsal branch flap

Objective To introduce the techniques of using free digital artery dorsal branch flap to repair finger pulp defect, and evaluate the clinical outcomes. Methods Free digital artery dorsal branch flap was transferred to repair finger pulp defect in 6 fingers of 6 patients. The area of flaps ranged from 1.0 cm× 1.0 cm to 2.0 cm× 2.5 cm. The donor sites were dorsoradial or dorsoulnar aspect of the proximal phalanx of the injured finger or the adjacent finger. The donor areas were covered with full-thickness skin graft. Results All 6 flaps survived postoperatively. Follow-up period ranged fiom 6 to 18 months, with an average of 12 months. The texture and appearance of the flaps were satisfactory. Finger function recovery was good, with 0° to 60° range of motion of the distal interphalangeal joint. Two-point discrimination of the flaps was 6 to 11 mm. Primary healing was achieved in the donor area wound. Long-term follow up showed that the skin grafts were wearable. There was no ulceration, and the movement of the donor finger was not impaired. Conclusion Free digital artery doral branch flap transfer is an ideal procedure for repair of finger pulp defect. The technique is relatively straightforward. The reconstructed finger pulp is full, aesthetic and sensate. Key words: Surgical flaps; Finger injuries; Dorsal side flap of digital artery

Repair of fingertip defects of two neighboring fingers with proximal and distal pedicled island flap from finger base

Objective To introduce a new surgical procedure for repairing fingertip defects of two neighboring fingertips.Methods Seven cases of fingertip defects of two neighboring fingers were treated by transferring a proximal and a distal island flap harvested from the base of one of the involved fingers.The distal flap was transferred to repair defect of the same finger,while the proximal one was transferred to repair defect of the neighboring finger.There were defects of the index and middle fingers in 2 cases,defects of the middle and ring fingers in 4 cases,and defects of the ring and little fingers in 1 case.Finger pulp defect occurredins 8 digits,soft tissue defect distal to middle phalanx in 4 digits,and defect of ringer stump in 2 cases.Exoosure of the tendon,nerve or bone was seen in all cases.The size of the proximal flaps ranged from 1.2cm× 1.5 cm to 2.3 cm×1.5cm,while the size of distal flaps ranged from 1.0cm×1.0 cm to 1.5cm×1.0cm. Results All 14 flaps in the 7 cases survived completdy.One patient underwent secondary correction of crooked nail 6months after the fkap surgery.Postoperative follow-up rangea from 6 months to 18 months.All repaired fingers had satisfactory appearance and texture.Two-point discrimination was 8 to 12 mm.The good and excellent rate of finger function recovery was 95.7%according to the provisional functional assessment criterion for upper limbs issued by the Chinese Hand Surgery Society. Condusion The flap design of this procedure is based on the anatomical characteristics of communicating branches of the digital artery at the base of the finger.Two flaps from the base of the same finger are harvested to make full use of the harvestable area of the donor finger,and avoid damage to another finger.This procedure expands the applicable indications of finger base island flaps and is an ideal method to repair defects of neighboring fingers. Key words: Surgical flaps; Finger injuries; Microsurgery