Dorsal Digital Flap Research Articles

Clinical efficacy of dorsal digital nerve fasciocutaneous pedicle flap with superficial vein anastomosis in repair of the type III and type IV of fingertip defects

Objective To analysis the clinical efficacy of dorsal digital nerves fasciocutaneous pedicle flap (DDNFPF) with superficial vein anastomosis in the treatment of the type III and type IV of fingertip defect, and the relationship between the incidence of vein crisis and superficial vein anastomosis. Methods A total of 85 patients with 92 fingers, treated by DDNFPF from February, 2017 to December, 2018, were retrospectively analyzed. The superficial veins of 30 patients with 32 fingers were anastomosed, and 55 patients with 60 fingers were not. The difference of the superior rate and the incidence of venous crisis between superficial vein anastomosis and non-superficial vein anastomosis was compared by Chi-square test. The difference was considered as statistically significant when P<0.05. The regular postoperative followed-up was performed. Results The average followed-up time was (7.0±2.9) months. The incidence of venous crisis in anastomosis group (1/32) was lower than that in non-anastomosis group (13/60). The difference was statistically significant (χ2=4.217, P 0.05) . The repaired fingertips of the 2 groups were in good appearance, wear-resistant, stable holders and two-point discrimination was 5 to 8 mm. Conclusion DDNFPF for the type III and IV type of fingertip defect is safe and effective. A anastomosis of superficial veins in recipient area can significantly reduce the incidence of venous crisis. Key words: Dorsal digital nerve fasciocutaneous pedicle flap; Fingertip defects; Superficial vein anastomosis; Venous crisis

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

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.

Proximal dorsal digital artery pedicled island flaps for reconstruction of adjacent finger soft-tissue defect

Objective To assay the clinical effect of proximal dorsal digital artery pedicled island flap in treatment and sensory reconstruction of adjacent finger soft-tissue defect. Methods The study enrolled 21 cases of soft-tissue defect in 21 fingers treated from January 2013 to January 2014. All the defects were covered with the proximal dorsal artery pedicled island flaps raised from the adjacent finger. Index finger was injured in 7 patients, middle finger in 9 patients, ring finger in 4 patients, and little finger in 4 patients. Defect and flap dimensions varied from 1.9 cm × 1.5 cm to 4.3 cm× 2.3 cm and from 2.0 cm×1.7 cm to 4.5 cm × 2.5 cm respectively. Donor site was resurfaced with a full-thickness skin harvested from medial side of the upper arm. Postoperative flap appearance and two-point discrimination were evaluated. Total active motion (TAM) of the finger was evaluated after operation. Results All the flaps and skin grafts survived after operation. Duration of the follow-up was 6-18 months (mean, 14.7 months). Through the final follow-up, appearance and function of the flap were satisfactory, donor site healed well, and two-point discrimination was 5-9 mm (mean, 6.3 mm). TAM evaluation was excellent in 19 patients and good in 2 patients with the excellent-good rate of 100%. Conclusion The proximal dorsal artery pedicled island flap raised from the adjacent finger is an ideal choice in finger soft-tissue reconstruction, for the technique has advantages of high survival rate, satisfactory appearance and sensory function as well as few complications. Key words: Fingers; Soft tissue injuries; Surgical flaps; Microsurgery

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

Repair of skin defects at fingers by digital dorsal flaps based on vascular network

To investigate the therapeutic effect of digital dorsal flap based on vascular network for skin defects at fingers. From August 2005 to August 2010, 49 cases with 61 skin defects at fingers were treated with the digital dorsal flaps, including 19 at the index fingers, 19 at the middle fingers, 16 at the ring fingers and 3 at the little fingers. The defects were 42 at the distal end, 12 at the middle segment and 7 at the proximal segment. The flaps size ranged from 27 mm x 20 mm to 10 mm x 8 mm. 61 flaps in 49 cases survived completely. 52 fingers were followed up for 6-22 months. The aesthetic and functional results were both satisfactory. The flaps sensation was graded as S3, with a discrimination distance of 6-9 mm (median, 7.6 mm). No complication happened in donor sites. The digital dorsal flap based on vascular network has reliable blood supply with less morbidity to the main artery. It is safe and easily performed with good effect for skin defect at finger.

Flag flap - Kite flap Dorsal metacarpal flap

The flag flap is a pedicled dorsal digital flap, combining a skin paddle (the “flag”) and a vascular pedicle (the flag “pole”). Its vascularisation depends on the dorsal metacarpal arteries (DMCA). It has been described in 1963, by Holevitch [1] with harvest of a cutaneovascular pole; it has been brilliantly modified in 1979 by Foucher et al. [2–4] under the form of a unipedicled “kite” flap, although we would like to point out that Vilain has been using it since 1952 [5]. Usually harvested from the dorsum of the metacarpophalangeal region of the index finger, this flap is reliable, but it is more uncertain and less movable at the level of the other digits. Owing to its small size, it proves useful in hand traumatology because it does not sacrifice any major vascular axis. The kite flap is considered as a sensory flap (presence of a nerve supply) with a two-point discrimination, which can be assessed from 11 to 16 mm [1–6].

Distally based dorsal digital neurocutaneous flap for finger-pulp reconstruction

目的 介绍应用指背皮神经营养血管皮瓣修复指腹创伤缺损的临床经验,并探讨改善静脉回流的方法.方法 自2004年3月至2005年10月,共急诊应用远端蒂指背皮神经营养血管皮瓣,修复指腹创面大于2 cm者18例.旋转轴点在近侧指间关节(PIP)平面以近0.5 cm,皮瓣面积2 cm×2 cm～3 cm×4 cm,皮神经筋膜蒂长2～3 cm.均将指背皮神经与指固有神经吻接,并在旋转点远侧1 cm处结扎指背浅静脉.结果 术后皮瓣均有不同程度的静脉淤血肿胀,8例皮瓣出现张力水泡.13例随访超过6个月,皮瓣恢复保护性感觉.结论 指背皮神经营养血管皮瓣修复指腹创伤缺损,方法简单,成活可靠.在蒂部远侧结扎指背浅静脉干阻断倒灌和在末端旷置敞开,均能改善静脉回流,减轻皮瓣肿胀。

15: Clinical Application of Reverse Dorsal Digital and Metacarpal Flaps

15: Clinical Application of Reverse Dorsal Digital and Metacarpal Flaps

Innervated Reverse Dorsal Digital Island Flap for Fingertip Reconstruction

Various methods of fingertip reconstruction with a sensory flap have been reported. Digital island flaps or cross-finger flaps have to be used for large defects; however, the digital artery is sacrificed when creating conventional homodigital island flaps and 2 surgeries are required for the cross-finger flap. We describe our experience with an innervated reverse dorsal digital island flap that does not require sacrifice of the digital artery. We used innervated reverse dorsal digital flaps for fingertip reconstruction in 8 patients. The flap was supplied by the vascular network between the dorsal digital artery (the terminal branch of the dorsal metacarpal artery) and the dorsal branch of the digital artery. Venous drainage was through the cutaneous veins and the venous network associated with the dorsal arterial network. The flap was designed on either the dorsal proximal or the dorsal middle phalangeal region. The flap was harvested with the dorsal branch of the digital nerve (for the dorsal middle phalanx), the dorsal digital nerve (for the dorsal proximal phalanx), or the superficial branch of the radial nerve (for the thumb), which was anastomosed to the distal end of the digital nerve. After flap transfer the donor site was covered with a full-thickness skin graft. Of the 8 flaps, 6 survived completely, 1 had partial epithelial skin necrosis, and 1 showed central compression skin necrosis. Three flaps showed congestive changes from the first to the fifth day after surgery, which resolved by massage. All patients achieved satisfactory recovery of sensation; the static 2-point discrimination ranged from 3 mm to 5 mm and the Semmes-Weinstein test results ranged from 0.036 g to 0.745 g. The innervated reverse dorsal digital island flap provides another option for homodigital tip coverage. The advantages are that the digital artery is not sacrificed and only 1 surgery is needed. A disadvantage is the potential for venous congestion for the first 4 or 5 days after surgery.

Reverse Dorsal Digital and Intercommissural Flaps Used for Digital Reconstruction

Reverse Dorsal Digital and Intercommissural Flaps Used for Digital Reconstruction

Reverse dorsal digital and intercommissural flaps used for digital reconstruction

Reverse dorsal digital and intercommissural flaps offer a simple and versatile option for skin cover of distal finger defects, especially when other local flaps are not available. Twenty-one reverse dorsal digital flaps were used, on an outpatient basis, to cover dorsal soft tissue defects over or beyond the PIP joint. All the flaps were transposed as reverse island flaps. The average size of the defects was 2.5 cm 2 and they were all used to cover exposed tendon, bone, joint or a combination. Twenty flaps survived completely and did not present any feature of circulatory difficulty. Marginal necrosis of one flap was noticed, while two patients complained of swollen finger 6 months later. No morbidity was reported and the patients maintained good range of motion. Various other types of flaps that have been used to reconstruct distal digital skin defects are reviewed and compared with the reverse dorsal digital and metacarpal flaps.

Upper limb reconstruction with reverse flaps: a review of 52 patients with emphasis on flap selection.

Reverse flaps lend themselves to transposition from proximal to distal locations in the extremities. This series comprised 18 radial forearm flaps, 17 digital artery flaps, 13 posterior interosseous flaps, 3 lateral arm flaps, 2 dorsal digital flaps, and 1 dorsal metacarpal flap, all of which were utilized in a reverse pattern. The radial forearm flap was mainly chosen for defects involving part of the palm and the palmar aspect of the first web space. The posterior interosseous flap was more commonly utilized for resurfacing the dorsum, dorsal aspect of the first web space, and especially the hypothenar aspect of the hand. The lateral arm flap was used to reconstruct antecubital fossa and proximal forearm defects. All posterior interosseous and lateral arm donor areas were closed primarily. Sensate digital artery flaps yielded 5 mm on average static two-point discrimination in 6 to 18 months of follow-up. Functional and cosmetic results concerning the recipient and donor areas were found to be satisfactory. It was concluded that reverse flaps are versatile tools in the coverage of all kind of defects in the upper limb and should be thought of in the first place.

Expanded experience with the reverse dorsal digital flap and its use in complicated wounds of the dorsal aspect of more than one finger

Expanded experience with the reverse dorsal digital flap and its use in complicated wounds of the dorsal aspect of more than one finger