Finger Defects Research Articles

The esthetic reverse adipofascial cross-finger flap for nail bed and pulp defects

Introduction: Unlike volar or pulp defects of fingers, nail bed loss or defects are challenging for plastic and hand surgeons. It is difficult to achieve the best esthetic fingernails following nail bed defects. The reverse adipofascial cross-finger flap is a promising option for reconstructing more natural-looking fingernails. Materials and Methods: Twelve patients who underwent reverse adipofascial cross-finger flap for nail and pulp defects were reviewed. Results: All patients were satisfied with the esthetic appearance of their nail plate and color. Overall, 83.3% of patients graded their finger as excellent and good, compared to the normal finger on the opposite hand.

Free Vascularized Second-Toe Distal Interphalangeal Joint Transfer for Reconstruction of Finger Defects

Free Vascularized Second-Toe Distal Interphalangeal Joint Transfer for Reconstruction of Finger Defects

Kekuatan Hukum Pelekatan Sidik Jari Penghadap Oleh Notaris Pada Minuta Akta


 
 
 
 The notary's role is to provide legal protection to the people who use his services. The presence of a Notary is indispensable for the community concerned to hold a legal relationship with other individuals so that the Notary may also be liable. In the provisions of Article 16 paragraph (1) letter c of the Amendment Law, it is stipulated that in carrying out his position, the Notary is required to attach fingerprints on the minutes of the deed, giving rise to various polemics, because the said provisions do not stipulate further if in this case the smoker suffers from finger defects or events that result in damage to fingerprints which makes the investigator unable to put his fingerprint. The purpose of this research is to find out how the efforts that can be done by a notary against those who are unable to put fingerprints and the legal consequences of the absence of fingerprints against the strength of the deed. This research is a type of normative legal research. The results of this study indicate that efforts can be made by a notary if there are those who suffer from finger defects or experience events that cause fingerprint damage so that they cannot attach their fingerprints to the minutes of the deed, the relevant Notary can explain the matter at the end of the deed. he made it because the fingerprints attached to the address are an act that is required to a notary that can lead to administrative sanctions as contained in the Amendment Law. Due to the legal absence of fingerprints attached to the strength of the deed that is the deed made by the relevant Notary Public remains an authentic deed even though the fingerprints of the tappers are not attached based on Article 1869 of the Civil Code and the deed is valid and legally binding as long as the provisions contained in Article 1320 are fulfilled Civil Code.
 
 
 

Effect of venous anastomosis of the pedicled digital artery dorsal branch island flap in repairing fingertip or pulp defects of the same finger

Objective: To explore the effect of venous anastomosis of the pedicled digital artery dorsal branch island flap in repairing fingertip or pulp defects of the same finger. Methods: From February 2016 to September 2018, a total of 56 emergency cases (67 fingers) with fingertip or pulp defects in 2-5 fingers were admitted to the Second Hospital of Tangshan (hereinafter referred to as the author's affiliation), and the prospective research was conducted. The patients were divided into venous anastomosis group of 29 cases (35 fingers) and non-venous anastomosis group of 27 cases (32 fingers) by drawing lots. There were 18 males and 11 females in venous anastomosis group, aged 17 to 62 years, with wound area of 1.6 cm×1.3 cm-3.1 cm×2.4 cm after debridement. There were 17 males and 10 females in non-venous anastomosis group, aged 20 to 59 years, with wound area of 1.7 cm×1.2 cm-3.0 cm×2.4 cm after debridement. According to the location and size of the fingertip or pulp defect of patients in the two groups, the flap was designed on the dorsum of the middle or proximal phalanx of the injured finger. During the operation, the epineurium of dorsal branch of the proper digital nerve or the dorsal digital nerve carried by the flap was anastomosed end-to-end with the stump of proper digital nerve in the wound. One or two superficial vein (s) carried by the flap was/were interrupted end-to-end anastomosed with the superficial veins on the dorsum or palm of the wound surface in venous anastomosis group, and the venous anastomosis was not performed in non-venous anastomosis group. The flap size resected ranged from 1.8 cm×1.5 cm to 3.4 cm×2.6 cm in venous anastomosis group, and that ranged from 1.9 cm×1.4 cm to 3.3 cm×2.6 cm in non-venous anastomosis group. The donor site wounds in the two groups were resurfaced by free full-thickness skin graft harvested from the proximal forearm or the medial side of the upper arm. The blood circulation of the flap of patients in 2 groups was observed after operation. During follow-up after operation, the patients' satisfaction for the appearance of the flap was evaluated by Michigan Hand Function Questionnaire, the flap color was observed by the chief physician of the Department of Hand Surgery in the author's affiliation, and the incidence of flap pigmentation was calculated. Data were statistically analyzed with t test and chi-square test. Results: All the flaps of patients survived without tension blister in venous anastomosis group after operation. Tension blisters occurred in 6 cases (6 fingers) in non-venous anastomosis group due to venous reflux obstruction, and the flaps survived after removing some sutures of the pedicle and changing dressing. During follow-up of 8-20 months, with an average of 15 months, the patients' satisfaction score for flap appearance in venous anastomosis group was (4.6±0.5) points, which was obviously higher than (4.3±0.6) points of non-venous anastomosis group (t=2.482, P<0.05). The incidence of flap pigmentation in venous anastomosis group was 9% (3/35), which was significantly lower than 31% (10/32) of non-venous anastomosis group (χ(2)=5.498, P<0.05). Conclusions: The pedicled digital artery dorsal branch island flap with venous anastomosis repairs the same fingertip or pulp defects, resulting in unobstructed venous reflux, low incidence of flap pigmentation, good appearance and high patient satisfaction.

Dorsal Metacarpal Artery Flap: An Underrated Workhorse Flap for Reconstruction of Dorsal Finger Defects

The dorsal metacarpal artery (DMCA) flap is a versatile option in the armamentarium of the reconstructive hand surgeon, especially for resurfacing dorsal finger defects where the flap options are limited. The flap fulfills most of the reconstructive principles such as “to replace like with like” and is simple, reliable, and easy to harvest with minimal donor site morbidity. In this report, we discuss the case of a 37-year-old male patient who presented with a partially healed wound over the right middle finger. Several variations of the DMCA flap have been described in the literature, and these are briefly described here along with their applications and vascular basis.

Hypothenar Island flap: a safe and excellent choice for little finger defects

Objective The aim was to evaluate the functional and cosmetic results of hypothenar island flap for the reconstruction of little finger defects and to assess them by follow-up. Background Reconstruction of soft-tissue defects of little finger of the hand needs a single-stage procedure that can provide well-vascularized coverage at the earliest stage to give the best functional result. Patients and methods This follow-up study that included 19 patients (13 men and six women) was carried out in the Plastic and Reconstructive Surgery Departments of Menoufia University and Helmia Military Hospital from October 2017 to October 2019, with assessment by a follow-up period of 12 months and physiotherapy. All the patients studied had the hypothenar island flap for coverage of the defects. The defects were due to postblunt trauma in three cases, post-burn in three cases, and post-sharp trauma in 13 cases. The largest flap was 20 × 15 mm2. The donor site was directly closed in all cases. Results The overall results were satisfactory regarding the function and appearance without major complications according to patient and doctor satisfaction. Regarding flap course and survival, 14 (73.7%) flaps passed uneventfully, five (26.3%) flaps suffered from venous congestion, five congested flaps survived without total loss and only partial loss and thus we had 19 (100%) survived flaps. Conclusion Hypothenar island flap is a reliable and versatile source for coverage of soft-tissue defects of little finger of the hand.

The Role of Reversed Homodigital Island Flap in Digital Reconstruction

Background: Fingertip injuries are very common. Reconstructionof extensive distal phalangeal defects with exposureof tendon, bone, or joint can be particularly a difficult problem.Options are local, regional and free flaps. SSG on bone andtendon is unsuccessful and nondurable. The primary goals ofdigital reconstruction are to preserve digital length and maintainfull mobility of the digit with providing adequate protectivecover of the deeper vital structures with soft tissue and skinof good quality. Homodigital artery island flap has been foundto be very useful and is commonly used for the recon‌structionof fingertip amputations.Patients and Methods: We used the reversed homodigitalartery island flap to reconstruct fingertip injuries in 8 patientsat Minia University Hospital and private sector in the periodbetween January to December 2017. We retrospectivelyanalyzed patients for: Age, sex, mechanism of injury, locationof defect, flap survival, sensory recovery and donor sitecoverage.Results: Five patients were males and 3 females. Agefrom 18 to 42 years mean (27.3 years). Six patients hadcomplete flap survival and two patients suffered venouscongestion that resolved completely by conservative measures.Donor site closure was directly closed in all cases. Nearnormal sensory recovery was noted.Conclusion: The reverse homodigital island flap is a safemethod for distal phalangeal reconstruction offering multipleadvantages over other local, regional and free flaps with analmost negligible donor site defect. Venous congestion andinability to reconstruct proximal finger defects are drawbacks

Finger reconstruction with dorsal metacarpal artery perforator flaps and dorsal finger perforator flaps based on the dorsal branches of the palmar digital arteries – 40 consecutive cases

Since the first description many variations of the dorsal metacarpal reverse island flap have been published but there is still uncertainty about which vascular component should be included for an optimal result. Therefore, it was the aim of this study to analyze vascular reliability and ischemic complications of dorsal metacarpal artery perforator (DMAP) flaps and dorsal finger perforator (DFP) flaps in our patient collective. We performed 40 of these flaps from the dorsum of hand and fingers for finger injuries. The choice of donor site was made according to the defect’s location. Patients were analyzed with respect to flap necrosis, ischemic complications and achievement of overall reconstruction goals. In addition, we divided our patients in two groups, one group where we raised the flap from the dorsum of the proximal phalanx and a second one where the flaps were raised from the intermetacarpal space to identify complication rates based on the pedicles location. Of the 40 flaps, 36 survived completely. 4 partial necroses were observed in flaps transferred to more distal defects and in one flap that was used in a wrap-around technique for both dorsal and palmar proximal phalanx. These perforator flaps are a reliable method to cover finger defects and the dorsal metacarpal artery is not necessary for their survival, since the blood supply comes from perforating branches of the palmar vascular system. There is a clear trend for a higher complication rate in flaps raised from the dorsum of the fingers compared to the intermetacarpal space.

Comparison of therapeutic efficacy between venous flap and the flap with superficial palmar branch of radial artery in reconstruction of the defect of finger with segmental defect of proper digital artery

Objective To compare the effectiveness of venous flap and the flap based on superficial palmar branch of radial artery (SPBRA) in the reconstruction of the defect of finger with segmental defect of proper digital artery. Methods From July, 2014 to March, 2018, 40 patients with soft tissue defects of finger and the proper arteries were treated by the venous flaps (18 cases, group A) and the flaps based on SPBRA (22 cases, group B). The operative time, postoperative 2-PD of the flaps, appearance, patient satisfaction, flaps donor site complications, flaps survival rate and the motion of digital joints were observed and compared by software SPSS 17.0. P<0.05 was considered statistically significant. Results Forty flaps all survived, and the wounds healed primarily. The operative time of group A was (78.89±7.36) min, which was shorter than that of group B (97.27±9.26) min, with statistically significant difference (P 0.05). Conclusion A higher survival rate and satisfactory clinical efficacy can be achieved by the venous flaps and the flap based on SPBRA while the area of defect in hand soft tissue, where there exists a segmental defect of proper arteries, is small. In terms of the recovery of sensing, the first choice is the flap based on SPBRA. In considering of the difficulty in surgical operation, the venous flap is a relatively simple procedure. Key words: Superficial palmar branch of radial artery; Venous flap; Finger injuries; Microsurgical operation

Repair of large soft-tissue finger defects with super-thin mobile abdominal flap at thickness of finger skin

Background: The repair of soft-tissue defects on fingers usually utilize hand and finger flaps near the defect area. Regional flaps are insufficient for multifinger defects or defects larger than 5 cm, while pedicle flaps produce esthetically and functionally unsatisfactory outcomes due to the thickness of the donor tissue. This study investigates the use of abdominal flaps prepared to match the thickness of finger skin. Material and Methods: A total of 12 fingers (six patients: 3M, 3F, average age: 27), all with soft-tissue defects, that required local flap surgery but for which adjacent local flaps were not sufficient, were included in this study. Random glove-like mobile abdominal flaps prepared from the inguinal region, were applied in similar thinness to the defect skin on all fingers. Results: Cases were followed postoperatively for an average of 7 years. Flap necrosis was not encountered in any patient, and no patients required additional surgery. esthetically and functionally, satisfactory results were obtained by treating large finger defects caused by injuries using this method. Conclusion: We demonstrated that a mobile flap harvested at the thickness of finger skin can be adapted to the finger in such a way that the finger can remain completely outside. This method is favorable and reliable in situations where local flaps are inadequate, such as in the treatment of finger wounds with large defects, multiple finger injuries necessitating circumferential style repairs or where distant and free flaps would lead to esthetic and functional problems.

Usage of Reversed Radial Forearm Flap for Reconstruction of Hand and Wrist Defects

Objectives: To highlight the usefulness of reverse radialforearm fasciocutaneous flap in covering various soft tissuedefects of hand and wrist.Study Design: Descriptive, experimental study.Setting: Department of Plastic & Reconstructive Surgery,Tanta University Hospitals.Material and Methods: A total of 15 reverse radial forearmflaps were utilized to cover various soft tissue defects of handand wrist from various etiologies including road traffic accidents,mechanical trauma, and industrial trauma and fireworksinjuries were included. Patients with segmental bone loss andthose patients having partial of complete amputation of thumbwere excluded. The age ranged from 22-43 (mean 22.5) years.Soft tissue defects of dorsum were covered with this flap in7 cases, 3 cases on palmer aspect and 5 cases for 1st webspace and the index finger defects each. Patients were followedfor at least three months post-operatively.Results: We had partial loss of flap in two cases that wasmanaged with debridement and skin grafting. Superficialepidermolysis was found in one case and managed conservatively.Donor site was skin grafted in 13 cases, which washealed uneventfully and quite acceptable to the patients indue course of time and direct clousure in 2 cases.Conclusion: Reverse radial artery flap has a quite longarc of rotation, which brings it great ease to cover the softtissue defects of various areas of hand like palm, dorsum,first web space.

Application of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger

Objective To explore the clinical efficacy of free super-thin venous skin flap of dorsal foot for repair of soft tissue defects of finger. Methods From January 2017 to January 2018, 14 patients with soft tissue defect of finger were treated. The super-thin venous flaps were harvested from the dorsal foot according to the area of finger defects. The wound was repaired by arterialization of veins. The dorsal cutaneous nerve of foot was incised in 4 cases. The donor site was sutured directly. The functional exercises were started after 2 weeks of immobilization. Results All the patients were follow-up for 6 to 12 months, 11 cases survived uneventfully, 2 cases had partial necrosis of skin flaps, and 1 case lost follow-up after 3 months. The partial necrosis of skin flaps healed after dressing change. 10 cases had two-point discrimination of 11 to 13 mm, and 4 cases with nerve in flaps had two-point discrimination of 7 to 9 mm. Conclusion It is simple and satisfactory to repair finger tissue defects with super-thin venous skin flap of dorsal foot. The donor site can be sutured directly and the sensory function can be reconstructed simultaneously with dorsal foot nerve excision. Key words: Finger injuries; Surgical flaps; Arterialized venous; Super-thin skin flap

The free neurovascular transverse wrist crease flap for repairing soft tissue defects of the fingers: clinical outcomes of multiple centers

BackgroundFlap transplantation is often needed for soft tissue defects of the fingers that cannot be closed directly. Sensory reconstruction of the fingers is important for patients to recover feelings. In this study, we report clinical outcomes of using free neurovascular transverse wrist crease flap for repairing finger defects from multiple centers.MethodsThis case series includes 72 consecutive patients with finger defects between June 2013 and June 2016 from multiple centers. A neurovascular transverse free radial artery superficial palmar branch flap, named transverse wrist crease flap, was designed to reconstruct soft tissue defects of the fingers with microvascular anastomosis. When there were soft tissue defects of the fingers with digital nerve defect, end-to-end neurorrhaphy between the median palmar cutaneous branch and the digital nerves was also performed. The donor incision was sutured directly. All the patients were followed-up for more than 24 months.ResultsThe soft tissue defects of the fingers were all completely covered with this free neurovascular transverse wrist crease flap, and the flaps in 71 patients survived completely without ischemia. Vascular crisis appeared in one case, and the wound healed gradually after changing wound dressing for nearly 1 month. Slight infections of wounds appeared in eight cases. There were no complications in the donor site, like infection and poor wound healing. At the last follow-up, the mean static two-point discrimination was 9.6 ± 2.4 mm on the injured finger and 4.5 ± 0.8 on the contralateral corresponding finger. The motion range of the distal interphalangeal joint and proximal interphalangeal joint on the injured finger were 72.5 ± 23.3% and 78.7 ± 32.5% of the contralateral corresponding finger, respectively. Patient self-evaluations were good in 53 cases and fair in 19 cases.ConclusionsThe results indicate that the free neurovascular transverse wrist crease flap is a good choice for repairing soft tissue defects of the fingers.Level of evidenceTherapeutic IV

Application of Dermal Skin Substitutes for Hand and Finger Palmar Soft Tissue Loss.

Summary:Restoring function after traumatic defects of the palm is a reconstructive challenge, considering the need for flexible, elastic, and resistant skin. Dermal skin substitutes are biologically engineered materials composed of collagen and glycosaminoglycan, devoid of cellular structures. These biodegradable materials act as artificial dermis and stimulate neovascularization: they have been used for many years, mainly on the dorsal side of the hand and fingers, whereas the palmar side of the hand has been generally addressed by local flaps. In this study, we described our experience with dermal skin substitutes in two cases of palmar defects associated with exposed tendinous structures. Coverage of palmar defects in hand and fingers with dermal substitute and split thickness skin graft was performed on two patients. Both patients presented palmar-only loss of tissue (traumatic palmar amputation in the first patient and degloving-type injury in the second patient). Range of motion, functional outcomes, and satisfaction and aesthetical results were evaluated. The resulting skin showed good quality, thickness, pliability, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Additionally, the patients regained full range of motion and reported high satisfaction. The association of split thickness skin graft with dermal substitutes in palmar traumatic hand showed optimal functional and aesthetic outcomes. Although being more adapted to dorsal loss of substance, collagen-based dermal substitutes can also be useful reconstructive tools in palmar defects with exposed structures and could be used to a larger extent in the future.

Finger defect coverage with digital artery perforator flaps

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

Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects

It was found that conventional toe graft alone could not meet the patients' needs for wound repair, so we hypothesized that it would be more effective to treat thumb and finger defect by toe graft with dorsalis foot flap. This prospective study was conducted in 104 thumb defect patients to investigate the clinical effect of thumb reconstruction using toe graft with dorsal foot flap for the treatment of thumb defects. These patients were randomly divided into the dorsal foot group and the control group by randomized double-blind method, with 52 patients in each group. The second toe was used for thumb reconstruction transplant in both the groups. After thumb reconstruction, the abdominal pedicled flap was used to repair the surgical wound in the control group whereas the dorsal foot flap was used to repair the surgical wound in the dorsal foot group. Three months after surgery, the efficacy of surgical treatment, evaluation of two-point discrimination, postoperative complications, function of reconstructed thumb, operation time, and hospitalization time were recorded and compared between the two groups. MHOQ questionnaire was used to evaluate and compare the patients' satisfaction with finger reconstruction in both the groups. The surgical therapeutic effect, the function of the reconstructed thumb, and satisfaction with finger reconstruction were significantly higher in the dorsal foot group compared to the control group (all p < 0.05). The postoperative two-point discrimination, postoperative complication rate, operation time, and hospitalization time of patients in the dorsal foot group were significantly lower compared to the control group (all p < 0.05). Thumb finger reconstruction using the second toe transplant with dorsal foot flap had a beneficial effect on thumb defect patients. It can effectively improve finger function and sensory recovery of patients while reducing complications.

The Versatility of the Superficial Circumflex Iliac Artery Perforator Flap: A Single Surgeon's 16-Year Experience for Limb Reconstruction and a Systematic Review.

The superficial circumflex iliac artery perforator (SCIP) flap is a versatile option of free tissue transfer for small to large defects. In this study, we examine the advantages of the SCIP flap, its cadaveric anatomy, and clinical subtypes. Ten cadavers were dissected and the corresponding pedicles of the SCIP and groin flaps were identified. A retrospective review of 20 clinical cases of free SCIP flap reconstruction was undertaken. The indication for reconstruction, flap dimensions, and survival were analyzed. A systematic literature review was conducted including articles that have previously reported the use of the SCIP flap. The SCIP pedicle was present in all our cadaveric dissections. The starting point of its pedicle ranged from 1.5 to 4.5 cm along the superficial circumflex iliac artery. The median diameter of the perforator and its concomitant vein was 1mm (range 0.8-2 mm). A cutaneous vein (1.3-2.3 mm) could be included in the flap if the concomitant vein was too small. Twenty consecutive patients had free SCIP flaps between 2002 and 2018. The indications were for finger defects (n = 8), thumb reconstruction (n = 1), lower limb compound fractures (n = 3), iatrogenic wounds (n = 2), upper limb large defects (n = 2), and scar contractures (n = 4). Flap dimensions ranged from 2 × 4 cm to 14 × 25cm, and the longest pedicle was 8cm. All flaps survived. The systematic literature review identified 34 previous reports using the SCIP flaps, most of these published by Asian units. The SCIP flap is useful for reconstruction throughout the body due to its ease of dissection, thinness, adjustable pedicle length, and flap dimension ranging from tiny to large, as well as the feasibility of raising a compound flap incorporating an adipofascial or vascularized bone component if necessary.This is a level of evidence therapeutic IV study.

Repairation of composite distal soft tissue defect of thumb and finger with mini toenail flap

Objective To introduce the repairation procedure of composite distal soft tissue defect of thumb and finger with mini toenail flap. Methods From June, 2015 to June, 2018, 7 cases with composite tissue defect at 7 distal fingers, including 5 thumbs, 1 index finger and 1 middle finger, were reconstructed with mini toenail flap transfer. The flap sizes which were raised during the operation ranged from 4.5 cm×3.0 cm-3.0 cm×1.5 cm. The donor sites were covered by toe phalanx shortening, V-Y advancement flap and local pedicle flap. Microsurgical routine treatment was made after the operation, and followed-up regularly. Results Seven flaps of 7 cases completely survived without any necrosis. All the wounds at the donor sites healed well. All patients were followed-up for 6-36 months. The motive, sensor and cosmetic result were satisfied. In sensory function, the two-point discrimination distance could restore to be 4-6 mm. Conclusion The mini toenail flap transfer is a reliable and suggested method. It can anatomically restored the distal digit sensor function with cosmetic contour, and regain the motive, sensory function and satisfied cosmetic appearance. Key words: Toenail flap; Toe transplantation; Finger; Repairation; Distal finger defect

Use of a vascularized dorsal sensory branch of an ulnar nerve flap for repairing a proper digital nerve with coverage of a volar soft tissue defect: Report of two cases

To repair a short nerve gap, autograft, allograft, autogenous, or synthetic conduits are selected, but a vascularized nerve autograft is preferred to obtain a reliable postoperative outcome in the case of an unfavorable wound bed. The purpose of this report is to describe and evaluate two cases of repair of a proper digital nerve and volar soft tissue defect with a vascularized dorsal sensory branch of an ulnar nerve flap. The cases of two men, 40 and 20 years old, who suffered index finger defects due to crush lacerations that required a flap and a nerve graft, are presented. A 4.0 cm × 2.0 cm and a 3.2 cm × 1.6 cm flap, which were nourished by the perforators from the ulnar proper digital artery of the little finger, were elevated from the ulnar side of fifth metacarpal bone head and transferred for coverage of the soft tissue defect. A 4.6-cm and a 3.0-cm vascularized nerve graft was interposed in the nerve gap. The patients' postoperative courses were uneventful, and both patients had no complaints related to the donor site. Static and moving two-point discrimination were 8 and 6 mm, respectively, at 6 months after surgery in the first case and 5 and 3 mm, respectively, at 9 months after surgery in the second case. This flap, which could be elevated in the same operative field with a nerve having similar diameter to that of the proper digital nerve, was useful for repair of a finger volar tissue defect.

Surgical outcome of the patient with open proximal phalangeal fracture with bone defect due to dog bite injury treated with vascularized bone graft: a case report

A dog bite injury involving joints and bones has poor prognosis. We described a case of open proximal phalangeal fracture with bone defect of the left index finger due to dog bite injury. The patient was treated successfully with a pedicled second metacarpal vascularized bone graft based on the second dorsal metacarpal artery following debridement and external fixation. Subsequently, extensor tendon tenolysis wrapped with adipofascial flap based on the first dorsal metacarpal artery was performed. After obtaining supple joint of the finger, flexor tendon tenolysis was performed. The postoperative course was uneventful, without infection. Nineteen months after the last operation, there was slight pain in the finger at power grip, but no disability in activities of daily life and work. The total active motion of the left index finger was 245°, and plain radiography showed bony union without osteoarthritic change. Good clinical outcome was obtained through a combination of staged surgery. Level of evidence: Level V, therapeutic study.