Finger Defects Research Articles

Groin Flap Experience in the Reconstruction of Soft Tissue Defects of the Hand

Objective: Pediculated groin flap has been playing an important role in hand reconstructive surgery for a long time. In this study, the cases where pediculated groin flap in the reconstruction of soft tissue defects of the hand was used are presented in terms of literature. Material and Methods: The cases included in the study where a groin flap was used for hand defects between 2010 and 2014 in the Plastic, Reconstructive, and Aesthetic Surgery Department. The age, gender, reason of defect, its localization, groin flap size, donor area closure method, flap separation time, other treatments, and complications were thoroughly examined. Results: Twenty-two groin flaps were used in 13 male and 7 females. It was used to close the amputated part in 8 patients as a result of finger amputation and degloving injury, in 3 patients as a result of hand and finger crush defect, in 1 patient as a result of burn finger defect, in 5 patients for extension contracture, and in 3 patients for flexion contracture due to burn sequel. Flap loss was not recorded in any of the cases. Conclusion: Pediculated groin flap is a good alternative that can be easily and safely used in suitable cases and has an important place in the reconstruction of hand defects.

Anatomical and histological study to determine the border of sole skin.

Transfer of a free skin graft from the submalleolar or plantar instep area to the palmoplantar area and finger defects is widely performed; however, the sites and the border of plantar skin have yet to be examined in detail. The aim of this study was to determine the border of sole skin. Twelve paraformaldehyde-fixed cadavers were examined. Skin specimens were harvested from an area from the top of the medial malleolus extending to the top of the lateral malleolus of the right foot. The paraffin-embedded skin specimens were analyzed using histological (hematoxylin and eosin, Fontana-Masson, and elastica van Gieson stains) and immunohistochemical (cytokeratin 9) techniques. CK9-positive cells were present at the points between 21 and 78% of the intermalleolar distance measured from the tops of the medial and lateral malleoli. The melanin index abruptly changed at the points 25±7.1 and 75±4.2%. The skin thickness and amount of elastic fibers changed greatly at the points between 20 and 30% and between 70 and 80% of the intermalleolar distance. Submalleolar skin is quite different from sole skin. The border of sole skin lies at the points between 20 and 25% of the intermalleolar distance from the medial malleolus, which macroscopically corresponds to the border of skin maceration. It would be better to use the submalleolar area for grafts for the dorsum of the fingers or toes, and the plantar instep area for the ventral areas of the fingers or toes.

Management of Hand and Digit Soft Tissue Injuries Using Free Fascia and Fasciocutaneous Flaps with Neo-Syndactylization

Traumatic hand and digit injuries result in complex challenging wounds that require the need for soft tissue coverage of exposed vital structures at the dorsal and palmar surface of the hand. Thin and supple tissue provides the best coverage for hand and finger defects because these tissues ultimately allow for stable wound coverage and improved range of motion with an acceptable aesthetic result. Given the limited amounts of expendable soft tissue in the distal upper extremity these devastating injuries usually require microvascular free tissue transfers with immediate syndactylization of the affected digits to provide soft tissue coverage. The authors review their experience in treating these complex hand and digit injuries using either free fascia or fasciocutaneous flaps with neosyndactylization of adjacent digits.

A Case of Harvesting Anterolateral Thigh Flaps Twice from the Ipsilateral Thigh of a Single Patient in Separate Operations

Until now, harvesting of flap elevations from the ipsilateral thigh twice in the same patient in two operations has not been reported. We harvested thigh flaps twice from the ipsilateral thigh of a single patient in separate operations. A 44-year-old man had skin defects of the right thumb and the left middle finger. In the first operation, his right thumb was reconstructed by the hemi-pulp flap. The anterolateral thigh flap harvested from the left thigh transferred to the donor site defect of the hemi-pulp flap. Sixteen days after the first operation, another anterolateral thigh flap harvested from the left thigh transferred to the defect of the left middle finger. This operative procedure is very useful for cases requiring multi-flap transfer.

Covering the Dorsal Finger Defect with Reverse Cross Finger Flap

Covering the Dorsal Finger Defect with Reverse Cross Finger Flap

Skin grafting in the treatment of open injuries of hand and fingers

The amount of open injuries of hand and fingers is equal to 55.1 % among all hand injuries and their consequences. They are often associated with tissue defect and lead to the loss of hand function. These injuries are recommended for surgical treatment with skin grafting in order to avoid amputation of injured segment. Different variants of autografting are summarized and illustrated in the article. The choice of autografting method depends upon the features of damage and clinical task — free (epidermis flaps, split-thickness and full-thickness skin grafts) and non-free (Italian, Filatov-Gillies pedicle grafting) flap coverage of wound. Their advantages and disadvantages are listed. The requirements for the performing of different types of grafting are identified. The peculiarities of prevention of cicatrical contraction development are described. Author draws attention to the special features of palm skin on hand and fingers, that limits usage of local skin flap. Methods of wound coverage on fingers and hand depend on their localization, size, and depth of tissue damage. Recommendations for coverage of donor wounds are noted. The necessity of saving of the finger terminal phalanges, especially 1st finger, is emphasized. Author showed the treatment techniques in the cases of butt defects of fingers.

Second toe microsurgical free-flap for aesthetic and sensory reconstruction of palmar soft tissue defects of fingers

To illustrate the surgical methods and clinical efficacy of microsurgical free-flaps obtained from second toe for the reconstruction of palmar soft-tissue defect of fingers. We enrolled 22 patients (13 men and 9 women), who received second toe free-flap for 22 finger defects between August 2007 and July 2013. The average age was 35 years (range, 18-62 years). The average size of flap was 2.7 cm × 2.0 cm (range, 1.5 cm × 1.5 cm-3.5 cm × 2.5 cm). All flaps survived well without any complications. Follow-up period ranged from 8 to 30 months (mean 15 months). The Visual Analog Scale for flap appearance (VAS flap) was ranged from 8 to 10 (average, 9.5). Based on the CISS questionnaires, 6 cases had mild cold intolerance. The average value of Michigan Hand Outcome Questionnaire (MHOQ) scoring for overall hand function was 8 (range, 5-13). The sensibility outcomes in 10 patients who underwent nerve repair were satisfactory. Average value of static two point discrimination (2PD) was 6.4 mm (range, 4-10 mm) and SWM test was 3.45 (range 2.83-4.12). Second toe free micro-flap is a very useful and reliable alternative for the reconstruction of palmer soft-tissue defect of fingers. IV.

Hypothenar island flap: A safe and excellent choice for little finger defects.

Soft-tissue defects of the little finger are challenging especially when bone, tendon or vascular pedicle is exposed because of trauma. The hypothenar island flap is easy to harvest and has a good colour and texture match to the little finger pulp. We present nine clinical cases of soft tissue defects of the little finger covered using the reversed hypothenar fasciocutaneous island flap. This article intends to highlight the ease of elevation and good clinical results of the hypothenar flap which is rarely used.

Formation of social and household skills in children with hand defects.

PurposeThe aim of this study was to consider the peculiarities of forming social and household skills, and the criteria for their evaluation, as well as an assessment of functional capacity, in children with hand defects both before and after surgical treatment and rehabilitation courses using a system of games.MethodsWe elaborated and implemented a program of social rehabilitation of preschool children with congenital and acquired hand defects for the development of their functional capabilities and the formation of social and household skills after surgical treatment and prosthetics using play therapy methods. As part of this work, 140 preschool children aged 3–7 years underwent social rehabilitation. Most of the children had congenital hand defects—122 children (87 %): 96 children (79 %) with ectrodactylia, adactylia, hypoplasia, aplasia, hand splitting, club hand, or partial gigantism; 26 children (21 %) with congenital syndactylism and constricted bonds and 18 children (13 %) with acquired defects (burn deformity, amputation). 110 children (79 %) had reached the stage of surgical correction; 30 children (21 %) reached the stage of prosthetics. Most of the children participating in the experiment (78 children, 56 %) had defects of fingers on one hand. The program aimed at solving specific rehabilitation tasks: formation and improvement of all possible types of grip under the existing defect including those after surgery and prosthetics; development of tactile sensations in fingers; development of fine motor skills; increase in range of motion in all joints of the damaged hand; development of attention and concentration; formation of social and household skills appropriate to age; and development of the ability to achieve the set task.ResultsAnalysis of the level of social and household skills of children with hand defects undergoing rehabilitation treatment at the hospital depending on the age prior to medical and social rehabilitation showed that preschool children with hand defects in the age category of 3 years demonstrated the highest results in the level of social and household skills (31 %) as compared with children in other age categories. The indicators for children aged 4 and 5 years were slightly lower, 25 and 26 %, respectively. The lowest values were recorded among children aged 6: 20 %.ConclusionStatistically significant parameters of the level of functional capacity of hand grip and social and household skills in children with hand defects obtained in the course of the investigation indicated that the use of play therapy measures significantly increased the effect of medical treatment irrespective of the type of defect. These data indicate that play therapy measures given immediately after surgery or prosthetics can significantly increase the efficiency of rehabilitation even in its early stages.

Strong Focusing of Plasmonic Lens with Nanofinger and Multiple Concentric Rings Under Radially Polarized Illumination

The strong focusing and field enhancement effects of a metal nanofinger surrounded by multiple concentric rings are investigated through both COMSOL Multiphysics and finite-difference time-domain (FDTD) simulations. The aspect ratio of the nanofinger is the main parameter determining the full width at half maximum (FWHM) and the strong local field enhancement. The optimal values of the aspect ratio for the maximal enhancement and minimal FWHM are close to 1.8 and 3.0, respectively. Furthermore, the optimal aspect ratio of maximal field enhancement intensity decreases linearly with the incident wavelength, and the optimal aspect ratio of minimal FWHM increases linearly with the metal film thickness. The nanofinger fabricated with the focused ion beam method has a small conical angle, which results in a higher field enhancement and smaller focal spot size than straight sidewall finger. However, the shorter finger defect deteriorates FWHM and field enhancement because of the bias from the optimal aspect ratio value.

Heterodigital flaps for severe pulp defects

Heterodigital flaps for severe pulp defects

Full-thickness skin grafting with de-epithelization of the wound margin for finger defects with bone or tendon exposure.

BackgroundFull-thickness skin grafts (FTSGs) are generally considered unreliable for coverage of full-thickness finger defects with bone or tendon exposure, and there are few clinical reports of its use in this context. However, animal studies have shown that an FTSG can survive over an avascular area ranging up to 12 mm in diameter. In our experience, the width of the exposed bones or tendons in full-thickness finger defects is <7 mm. Therefore, we covered the bone- or tendon-exposed defects of 16 fingers of 10 patients with FTSGs.MethodsThe surgical objectives were healthy granulation tissue formation in the wound bed, marginal de-epithelization of the normal skin surrounding the defect, preservation of the subdermal plexus of the central graft, and partial excision of the dermis along the graft margin. The donor site was the mastoid for small defects and the groin for large defects.ResultsMost of the grafts (15 of 16 fingers) survived without significant surgical complications and achieved satisfactory functional and aesthetic results. Minor complications included partial graft loss in one patient, a minimal extension deformity in two patients, a depression deformity in one patient, and mild hyperpigmentation in four patients.ConclusionsWe observed excellent graft survival with this method with no additional surgical injury of the normal finger, satisfactory functional and aesthetic outcomes, and no need for secondary debulking procedures. Potential disadvantages include an insufficient volume of soft tissue and graft hyperpigmentation. Therefore, FTSGs may be an option for treatment of full-thickness finger defects with bone or tendon exposure.

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.

The Usability of Medial Sural Artery Perforator Flap for Reconstruction of the Finger Defects

Traffic accidents or industrial accidents may be the most frequent cause of large finger defect injury, which can hardly be treated by replantation since it can cause stripping of skin and soft tissues and involve vascular injuries due to several injury mechanisms. Regarding the flap in reconstruction of large finger defects, it is necessary to conThe Usability of Medial Sural Artery Perforator Flap for Reconstruction of the Finger Defects

Expanding digits of a maxillofacial prosthodontist

Complete or partial loss of a finger is the most commonly encountered problem in prosthetic dentistry. The etiology of missing digit may either be congenital or acquired. Trauma is the most common cause for acquired defect of the digit. Loss of a digit results in functional and psychological impact on quality-of-life of the patient. This article portrays about the prosthetic management of a patient with an acquired defect of finger

Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction

The posterior interosseous artery (PIA) perforator flap can be used for reconstruction of soft-tissue defects of fingers. Based on the multiple perforators from the posterior interosseous artery, we describe a technique to reconstruct the multi-finger defect in the use of the free multilobed PIA perforator flap. PIA perforators from different areas of the forearm were used to design a free multilobed skin paddle for multi-finger skin defect reconstruction. Each paddle without the deep fascia had separate perforators. To increase the perforator pedicle length, the courses of the PIA perforators were dissected from the superficial layer of the deep fascia to the subcutaneous layer. The flap was raised as a unilateral free bilobed PIA perforator flap in 10 cases of two-finger defects, a free trilobed PIA perforator flap in two cases of three-finger defects, and a bilateral free bilobed PIA perforator flap in one case of four-finger defects. The average effective vascular pedicle length and trunk pedicle length were 8.3 and 3.1cm, respectively, for the bilobed flap, and 6.3 and 4.0cm, respectively, for the trilobed flap. All flaps survived except one paddle with tip necrosis. At 10.8 months (range, 4-27 months) after surgery, 10 cases showed satisfactory cosmetic appearance, while the fingers were bulky in the remaining three cases. The average score of static two-point discrimination in 10 innervated paddles was 12.9mm. The remaining 20 paddles recovered only protective sensation. The average total active motion (TAM) of each finger was 164° before surgery and 187° at the latest follow-up. Free multilobed PIA perforator flap is a good candidate for reconstruction of multi-finger skin defect. Therapeutic, Ⅳ.

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.

Clinical experience of reconstruction of multiple finger defects with bilateral second toe transfer

Objective To introduce the clinical experiences of reconstructing multiple finger defects by transferring bilateral second toes.Methods From August 2009 to June 2012,17 cases of multiple finger defects were treated with simultaneous transfer of bilateral second toes to reconstruct 34 fingers.Results All the 34 reconstructed fingers survived.Postoperative vascular crisis occurred in two fingers which survived after surgical exploration and re-anastomosis of the vessels with vein graft from the forearm in one case and local manipulation in the other.Plasty was done in 12 fingers 3 to 5 months after the primary surgery.Postoperative follow-up ranged from 6 to 24 months.According to the hand functional evaluation criteria,the results were graded as excellent in 10 fingers,good in 19 and fair in 5,with 85.3％ overall excellent and good rate.Conclusion Bilateral second toe transfer is one of the ideal methods to repair multiple finger defects among the available options. Key words: Transplantation; Fingers; Toe; Reconstruction; Defect

Modified Innervated Radial Collateral Artery Perforator Flap for Repairing Digital Defects.

The authors presented their clinical experience and demonstrated surgical methods to reconstruct soft-tissue defects in the digit by using modified innervated radial collateral artery perforator flap. Surgical procedures that involved 12 modified innervated radial collateral artery perforator flaps were performed in 12 patients. Among the patients, two had defects in the thumbs, six had defects in the index fingers, whereas two had defects in the middle fingers, two had defects in the little fingers. The flaps ranged in size from 5.0 × 2.0 to 7.5 × 4.0cm. The pedicle of the flap was divided and ligated below the level at which the radial collateral artery was divided into anterior and posterior branches. The recipient vessels were the proper digital artery and the palmar subcutaneous vein (n = 8), the deep branch of the ulnar palm artery (n = 4), and the venae comitantes. Nerve suture was done between the posterior cutaneous nerve of the arm and the proper digital nerve of the digital. The cosmetic appearance of the donor and recipient sites and static two-point discrimination of the operated finger were evaluated in a follow-up visit. Postoperative venous congestion happened in two cases, and both succeeded after exploration. All flaps survived, and all donor sites were closed directly, leaving a linear scar. Follow-up time ranged from 12 to 28months. Defatting of the flap was performed in two cases during the late postoperative period. Cosmetically acceptable results were achieved for the rest of the patients. The modified innervated radial collateral artery perforator flap is a good option for reconstructing soft-tissue defects in digits.

Color Doppler Imaging of an Ulnar Artery Perforator Forearm Flap for Resurfacing Finger Defects

Fingertip defect reconstruction with various free perforator flaps has been widely reported. We recommend a technique of using color Doppler imaging to locate ulnar artery perforator. And we used a free mesioforearm flap based on ulnar artery perforator for the reconstruction of fingertip defect. Since 2010, 7 fingertip defect cases have been repaired at our hospital using free mesioforearm flaps, based on the ulnar artery perforator. The free flap was designed according to Doppler detection. The flap contained perforator vessels and cutaneous nerves. The donor site was directly sutured or skin grafted. All 7 flaps survived with good quality and esthetic contours and grasp function of the hand was satisfactory. They were evaluated by 2-point discrimination, with 5 cases with neurorrhaphy of 6 to 8 mm and 2 cases without neurorrhaphy of 10 to 12 mm. Ultrasound is a suitable method for preoperatively locating the vascular pedicle. The free mesioforearm flap based on ulnar artery perforator is a good option to repair fingertip defect.