Dorsal Digital Defects Research Articles

A Comparison between Reversed Cross Finger Flap and Reversed Island Homo-digital Flap in Reconstruction of Distal Dorsal Digital Defects

The reversed cross-finger flap is a modification for cross-finger flap with the strategies of the hetero-digital island flap. In the reversed cross-finger flap, the digital artery opposing the distal communicating arch and the pedicle are included. Objective:

Reconstruction of Large Dorsal Digital Defects With Arterialized Venous Flaps

Coverage of the dorsal aspect of the fingers is difficult, especially when the defect is large and multiple digits are involved with composite tissue loss and very few conventional flaps are suitable in dealing with such situation. The purpose of this study was to present our experience of reconstruction of the large dorsal digital defects with the arterialized venous flap (AVF) and evaluate its merits and demerits in this clinical setting with a comprehensive review of literature. From August 2008 to December 2010, 7 composite palmaris longus venous flaps and 5 AVFs were used in the reconstruction of extensive dorsal digital injuries in 8 patients, and a comprehensive review of literature regarding the reconstruction of dorsal digital defects with AVFs was carried out. All the flaps survived completely. The outcomes were very satisfactory for functional recovery, aesthetic appearance, and sensation restoration at an average follow-up of 11.8 months; the literature review also revealed the similar results. On the basis of our experience and literature review, AVFs are reliable and good candidates for resurfacing large dorsal digital defects when local flaps are not available or insufficient for coverage. Composite AVF with palmaris longus tendon is an optimal choice for 1-stage reconstruction of dorsal composite finger injuries.

Vascularized tendon incorporated in reverse homodigital and heterodigital island flaps for the reconstruction of dorsal digital defects

An adequate range of motion (ROM) of the distal interphalangeal (DIP) joint is indispensable for fine motor skills of the hand. Reconstruction of extended skin and tendon loss of the distal phalanx is often challenging for surgeons and may lead to functional impairment of the injured finger. This article presents an option for a one-step functional and esthetical reconstruction of dorsal digital defects using combined island flaps. Vascularized tendons were harvested incorporated in reverse homodigital and heterodigital island flaps to treat skin and extensor tendon loss of patients over their DIP joints. In a 6-month follow-up, we evaluated the active ROM and fine motor skills of the involved fingers as well as the patients' satisfaction. Six months postoperatively satisfactory functional and sensory results of the donor site finger have been reported. The mean ROM for the recipient finger was 0°/25° for the DIP joint. All flaps remained viable and full finger length was preserved. Patients stated adequate till high satisfaction with respect to operation time, pain, and finger appearance. The vascularized tendon incorporated in reverse island flaps provides a sufficient method to restore function of the DIP joint after complex injury and prevents finger deformity, arthrodesis, or amputation.

Emergency reconstruction of the complex dorsal digital defect using the composite flap with extensor tendon graft from the second toe

To report emergency reconstruction of the complex dorsal digital defect using the composite flap with extensor tendon graft from the second toe. From February 2001 to March 2010, 6 fingers in 6 patients with complex dorsal digital defects were repaired using the composite flap. The defect of the extensor tendon was also repaired with the extensor tendon graft harvested from the second toe. All the flaps survived completely with primary healing. The patients were followed up for 5 to 10 years. The flaps had a good match in skin color and texture. Both the esthetic and functional results were satisfactory either in recipient or in donor sites. The emergency reconstruction of the complex dorsal digital defect using the composite flap with extensor tendon graft is an effective way to repair the skin defect and extensor tendon defect simultaneously with good long-term results.

Simultaneous coverage of two separate dorsal digital defects with a syndactylizing venous free flap

We report a case of a 58-year-old patient who sustained multiple finger injuries on the right hand. After thorough debridement, two dorsal defects of the middle and ring fingers were covered simultaneously with a single arterialized venous free flap from the right forearm. The flap was used to create a dorsally syndactylized digit which survived completely and was subsequently divided longitudinally. With early flap division, excellent functional and cosmetic result was achieved. We consider the syndactylized venous free flap with early division as a useful option for simultaneous coverage of separate dorsal digital defects.

The Versatile Reverse-flow Digital Artery Cross-finger Flap

Various flaps have been described for the reconstruction of the soft tissue defects of the digits, but these are not applicable to all kinds of defects. Moreover, these techniques are mostly 2-staged operations that require long-term immobilization. In this study, reverse-flow digital artery cross-finger flap was used to cover various volar and dorsal digital defects in 9 cases. Seven of 9 cases that had follow-up period longer than 2 years were evaluated, and all had good results. We recommend that reverse-flow digital artery cross-finger flap is a universal flap that can be used for almost all types of soft tissue defects of the digits.

The Bilobed Arterialized Venous Free Flap for Simultaneous Coverage of 2 Separate Defects of a Digit

We report a case of a 17-year-old patient who sustained multiple finger contusions on the left hand. After thorough debridement, the volar and dorsal defects of the middle finger were covered simultaneously with bilobed arterialized venous free flap from the left forearm. The flap was composed of 2 paddles, which were connected by a subcutaneous bridge containing a subcutaneous venous network. The subdermal plexus in the bridge was interrupted with no impairment of blood supply to the second cutaneous paddle. The flap survived completely with only temporary mild venous congestion. Excellent functional and cosmetic result was reached. We consider bilobed arterialized venous free flap as a useful option for coverage of concomitant volar and dorsal digital defects.

De-epithelialized Cross-Finger Flaps Versus Adipofascial Turnover Flaps for the Reconstruction of Small Complex Dorsal Digital Defects: A Comparative Analysis

To compare the results of 2 reconstructive options (the de-epithelialized cross-finger flap vs the adipofascial turnover flap) for coverage of small complex dorsal digital defects. A total of 73 patients with small complex dorsal digital defects were included in the study and were classified into 2 groups: group 1 (n = 31) had reconstruction using the de-epithelialized cross-finger flap and group 2 (n = 42) had reconstruction using the adipofascial turnover flap. The type of complication and patient dissatisfaction with the appearance of the donor site were documented in each study group. All flaps in both groups survived with no infection or hematoma. Specific complications were found in group 1 patients and included flap dehiscence (1 patient), considerable skin graft loss (2 patients), stiffness of the donor finger (5 patients), and inclusion cyst (1 patient). The only specific complication for group 2 patients was the occasional epidermolysis of the skin of the donor site, which was observed in 6 patients. Patient dissatisfaction with the appearance of the donor site was documented in 10 patients in group 1 and none in group 2. The elective flap division in the cross-finger-flap group was considered a disadvantage in children because it required general anesthesia. The versatility of both flap techniques in digital reconstruction is confirmed; however, considering the type of complication and the need for general anesthesia in children for cross-finger-flap division, the adipofascial flap was determined to be superior in the following specific groups: children, older patients, and patients with osteoarthritis and multiple defects of adjacent border digits.

The use of adipofascial turnover flaps for coverage of complex dorsal ring finger defects caused by electric burns

This paper describes a unique occupational electrical injury that results in a complex defect on the dorsal aspect of the ring finger. The injury was seen in seven electricians working while wearing a ring on the ring finger. All patients were treated successfully using random adipofascial turnover flaps. The electric current was found to cause a zone of subcutaneous necrosis adjacent to the skin burn. This zone of subcutaneous necrosis varied in size but never exceeded 5 mm and it was easy to recognize the extent of this zone intraoperatively because of the presence of the thrombosed dorsal subcutaneous veins within the necrotic subcutaneous tissue. These observations suggested that adequate debridement and then location of the base of the adipofascial flap proximal to the edge of the debrided area was an appropriate procedure. Other technical considerations were described to ensure a successful outcome. It was concluded that adipofascial turnover flaps were not only reliable in these electrical injuries, but also had several advantages when compared with other flaps commonly used to reconstruct dorsal digital defects.

Technical Modifications and Extended Applications of the Distally Based Adipofascial Flap for Dorsal Digital Defects

A series of 15 cases of distally based adipofascial flaps to cover dorsal digital defects is presented. All flaps were raised just superficial to the dorsal veins (and hence preserving some fat with the reflected flaps) rather than raising them at the subdermal plane. In 3 cases where there was another injury proximal to the defect, which precluded the use of an adipofascial turnover flap from the injured digit, a distally based cross-finger adipofascial flap was used from the adjacent finger. In 4 cases, the flap was used to cover compound fractures. The results showed complete survival of all flaps without loss of the overlying skin graft and without epidermolysis of the donor skin, indicating that raising the flap just superficial to the dorsal veins does not affect the reliability of its blood supply, and yet it enhances the blood supply of the reflected skin flaps. The series also showed uneventful healing of compound fractures covered by the flap, indicating flap reliability to cover exposed fractures. Finally, the study demonstrated the feasibility of using the flap as a cross-finger flap.

Bipedicle strap flaps in reconstruction of longitudinal dorsal skin defects of the digits.

Dorsal skin defects in which the loss of integument is longitudinal in shape are not uncommon after injury by rotating machinery and by glass shearing along the length of the digit. This shape of defect is difficult to reconstruct with commonly used flaps but lends itself to reconstruction by the use of longitudinal bipedicle strap flaps moved across the dorsum of the finger from lateral to medial. A variant of this traditional technique was used in the reconstruction of 28 dorsal digital defects. The incidence of these defects and the need for this reconstructive technique were analyzed by a review of 1077 patients with dorsal digital injuries treated in a 6-year period between 1989 and 1995. Approximately 20 percent of all dorsal digital injuries requiring flap reconstruction were suitable for reconstruction with bipedicle strap flaps.

Bipedicle Strap Flaps in Reconstruction of Longitudinal Dorsal Skin Defects of the Digits

Dorsal skin defects in which the loss of integument is longitudinal in shape are not uncommon after injury by rotating machinery and by glass shearing along the length of the digit. This shape of defect is difficult to reconstruct with commonly used flaps but lends itself to reconstruction by the use of longitudinal bipedicle strap flaps moved across the dorsum of the finger from lateral to medial. A variant of this traditional technique was used in the reconstruction of 28 dorsal digital defects. The incidence of these defects and the need for this reconstructive technique were analyzed by a review of 1077 patients with dorsal digital injuries treated in a 6-year period between 1989 and 1995. Approximately 20 percent of all dorsal digital injuries requiring flap reconstruction were suitable for reconstruction with bipedicle strap flaps. (Plast. Reconstr. Surg. 103: 1205, 1999.)