Finger Flap Research Articles

Evaluation of electrophotobiomodulation as a recent tool in the armamentarium of treatment of fingertip injuries

BackgroundTraditional reconstructive options of fingertip injuries are technically difficult, usually need donor site skin grafting, leave visible scars, and need a protracted period of finger immobilization resulting in joint stiffness. Electro-photobiomodulation (EPBM), is the process of combining intense pulsed light and radiofrequency to modify tissues to help the body heal itself, lower inflammation, and promote wound healing.Patients and methodsThis study included 60 patients presented with fingertip injuries. Patients were randomly divided into two groups. Group 1 includes patients who were treated by EPBM. Group 2 includes patients who were treated by cross finger flap (CFF). Six months after complete healing, evaluation was performed for aesthetic and functional outcome and patient satisfaction.ResultsCompared to group 2 patients, group 1 patients had statistically significant better sensory outcome, better total active motion of affected digits, grip strength, patient satisfaction, healing time, and plastic surgeon general aesthetic evaluation and also, they had statistically significant less adverse events and cold intolerance with absent donor site pain and deformity.ConclusionEPBM is safe and effective treatment of fingertip injuries which shortens the healing time, produces the best aesthetic and functional result while avoiding donor site morbidity of the traditional reconstructive options.

Treatment of Industrial Fingertip Crushing Injury with Cross Finger Flap

Treatment of Industrial Fingertip Crushing Injury with Cross Finger Flap

Cross finger flap with nail bed graft reposition on flap for allen type IV amputation in a 6 Year old child: A case report

We present a case of Allen type 4 traumatic amputation of the ring finger in a year old child for whom cross finger flap with gaft reposition on flap was done. The child was followed up for 2 years and presents with good cosmesis and no functional disability.The technique of harvesting the nail bed and repositioning over the distal phalanx along with cross finger flap is reliable and can be easily executed in such cases.

Clinical and operative risk factors for complications after Apert hand syndactyly reconstruction.

III.

Reverse Cross Finger Flap for Deep Defects Involving the Dorsal Digits.

Reverse Cross Finger Flap for Deep Defects Involving the Dorsal Digits.

675 Are Postoperative Outcomes in Flap Operations Affected by Obesity?

Abstract Aim To explore the outcomes of flap surgeries and how obesity affects them. To find if there is a correlation between CBC indices (also inflammatory markers) with flap survival. Method All flap surgeries on adults in the collaborating departments in an Indian tertiary care hospital from 2021-2022 excluding finger flaps were prospectively analyzed. Data of 90 patients including postoperative complications, preoperative Neutrophil-Lymphocyte Ratio (NLR) were recorded.BMI is calculated to classify patients based on Asia-Pacific guidelines where BMI>25 is obese, 23-24.9 is overweight, <18 is underweight.Chi square tests were used to assess association between obesity, NLR and early (within 7 days of surgery) &late (beyond 7 days) postoperative complications -flap loss, wound dehiscence, surgical site infection. Multiple regression model and ANOVA test were also done with these variables. Results There is significant association between patients’ obese or overweight habitus and postoperative surgical site complications. 38% early (p = 0.001) and 36% late (p = 0.044) complications happened in obese patients alone. There is significant association between NLR and early postoperative complications (p = 0.002).60% with high NLR values had severe early postoperative complications, compared to 16.7% of patients with normal NLR and 21.1% with mildly raised NLR. Obesity and high NLR [NLR 10-18 or moderate stress, NLR>18 or severe stress] independently have significant correlation (0.038 for obesity, 0.015 for NLR) with early postoperative complications. Conclusions Obesity combined with high preoperative NLR is a quick, inexpensive predictor of poor early postoperative flap survival.

Hand Reconstruction with Little's Flap, Cross finger Flap and V-Y Flap. A case report

Hand Reconstruction with Little's Flap, Cross finger Flap and V-Y Flap. A case report

Comparison of the Functional and Aesthetic Outcomes of Thenar, V-Y Advancement and Cross Finger Flap in Management of Fingertip Injuries in Children with Exposed Bone

Comparison of the Functional and Aesthetic Outcomes of Thenar, V-Y Advancement and Cross Finger Flap in Management of Fingertip Injuries in Children with Exposed Bone

Syndactyly in the Pediatric Population: A Review of the Literature.

Syndactyly is one of the most common congenital upper extremity deformities. Syndactyly can be described as either simple, involving just the skin and soft tissue, or complex, involving the phalanges. Additionally, syndactyly can be categorized as complete, involving the entire digit (including the nail fold), or incomplete, which does not involve the nail fold. Multiple familial or spontaneous genetic abnormalities can cause syndactyly, and these mutations typically involve the canonical wingless-type (WNT) pathway. Surgical repair of syndactyly is typically done between six to 18 months of age, depending on the type of syndactyly. Regardless of the classification of the syndactyly, the repair is performed before school-going age (except in the case of extremely mild or rare, extremely complex syndactyly). One or more imaging modalities are used to aid the surgeon in deciding the surgical approach for the syndactyly repair. The surgical plan must be clearly communicated with parents to manage expectations of aesthetics and function of the digits post-surgery. In brief, a syndactyly release surgery involves the creation of the web space using a geometrical design of the surgeon's choice, defatting of finger flaps, separation of the digits, and closure with absorbable sutures. However, the approach may vary depending on the patient. A "best" approach for rectifying the difference in surface area of separated versus fused digits has not yet been determined. While this was typically done using a skin graft, the use of alternative methods (most notably, using a synthetic dermal substitute or not using a graft at all and allowing the skin to heal with secondary intention) has been on the rise given the undesirable side effects of a graft. Less commonly, an external fixator can be used to expand soft tissue and skin. In the case of complete syndactyly, the Buck-Gramcko technique is most commonly used for nail flap reconstruction. Complications of the surgery include contracture, web creep, and the need for a second surgery. Thus, parents must be counseled in recognizing signs of complications.

Comparison of Treatment Methods of Thumb-Tip Defects With Phalangeal Bone Exposure: Modified Heterodigital Neurovascular Island Flap Versus Free Lateral Great Toe Flap

Modified heterodigital neurovascular island flaps and free lateral great toe flaps are dependable methods for treating thumb-tip defects with phalangeal bone exposure. We retrospectively analyzed and compared the details and results of the two methods. This retrospective study included 25 patients with thumb injuries with phalangeal bone exposure treated between 2018 and 2021. Patients were categorized as per the following surgical methods: (1) modified heterodigital neurovascular island flap (12 patients, finger flap group) and (2) free lateral great toe flap (13 patients, toe flap group). The Michigan Hand Outcome Questionnaire, aesthetic appearance, Vancouver Scar Scale, Cold Intolerance Severity Score, static 2-point discrimination, Semmes-Weinstein monofilament, and range of motion of the metacarpophalangeal joint of the injured thumb were evaluated and compared. In addition, operation time, hospital stay, return-to-work time, and complications were recorded and compared. In both groups, the defect was successfully repaired, with no cases of complete necrosis. The 2 groups had similar mean scores in static 2-point discrimination, Semmes-Weinstein monofilament, range of motion, and Michigan Hand Outcome Questionnaire scores. The aesthetic appearance, scarring, and cold tolerance of the toe flap group were better than the finger flap group. The operation time, hospital stay, and return-to-work time in the finger flap group were shorter than the toe flap group. The finger flap group had 2 complications-a superficial infection and 1 case of partial flap necrosis. The toe flap group had 3 complications-a superficial infection, 1 case each of partial flap necrosis, and partial skin graft loss. Both treatments can achieve satisfactory results; however, they each have advantages and disadvantages. Therapeutic IV.

Successful Use of WALANT in Local and Regional Soft Tissue Flaps: A Case Series.

A retrospective review was performed. Twenty-one patients who underwent a local or regional soft tissue flap surgery using the WALANT technique from February 2, 2018 to February 25, 2022 were included in our analysis. Overall, one Louvre flap, two posterior tibial artery perforator propeller flaps, two reverse radial forearm flaps, two Quaba flaps, six cross finger flaps, one reverse homodigital island flap, three first dorsal metacarpal artery flaps, two thenar flaps, and two Moberg flaps were performed. Patients were followed up for an average of 11.9 ± 8.1 weeks. During this time, no postoperative complications occurred. All patients demonstrated appropriate healing at donor and recipient sites. Full range of motion was regained for all patients. WALANT is safe and effective for use in local and regional soft tissue flap surgery. Surgeons should consider this technique for more involved procedures such as flap surgery, as preliminary results demonstrate positive outcomes and potentially superior recovery for patients.

Early division of cross finger flap for fingertip amputation shortens time to return work

Early division of cross finger flap for fingertip amputation shortens time to return work

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:

Effect of dorsal nerve fascial island flap on repairing distal soft tissue defects at the proximal segment of the index, middle, ring, and little fingers

BackgroundTo investigate the effect of the dorsal nerve fascial island (DNFI) flap on repairing finger soft tissue defects at the distal segments.MethodsFifty patients with distal soft tissue defects at the index, middle, ring, or little fingers were treated with a DNFI flap at the proximal phalanx between February 2008 and May 2018. The nutrient vascular chain around the dorsal branch of the proper palmar digital nerves served as the flap axis. The dorsal branch of the proper palmar digital arteries provided blood supply. The fascia pedicle served as the venous system. All patients were followed for 6 months.ResultsAll 50 flaps survived. The appearance, color, and texture of the skin returned to normal. The sensory function was partially restored. The two-point discrimination of the finger flap was 7–10 mm.ConclusionsThe DNFI flap at the proximal phalanges of the index, middle, ring, and little fingers is an effective surgical option. The technique has a high flap survival rate and long pedicle, which can repair different parts of the finger. The flap also restores the sensory function of the finger without damaging the main nerves or blood vessels. The flap treatment is an optimal option for finger soft tissue defects at the distal segments.

Management of Hand Injuries: a Six-year Experience from Komfo Anokye Teaching Hospital, Kumasi, Ghana

Background: Hand injuries can ruin patients’ ability to work with their hands. This could lead to depression and social isolation. It is imperative that hand injuries be reconstructed to as near normal as possible.Patients and Method: A prospective study was undertaken from January 2005 to December 2010 at the Komfo Anokye Teaching Hospital, Kumasi, Ghana to document the pattern of hand injuries, and the outcome of management. The patients were evaluated clinically. Wound debridement was done; the defects were repaired using reconstructive techniques matched to the type of injury.Result: Ninety-five patients (71 males) were treated. Male: female ratio was about 3:1. Their ages ranged from 2 to 60 years with mean (± SD) of 29.5 (± 12.9). Of the 102 hands injured, 52 were right. The right was the dominant hand in 65%. Both dominant and nondominant hands were injured equally. 5% of the injuries were isolated; 95% were combined. The distribution of mechanisms of injuries was as follows: avulsion, sustained through road traffic accidents (37%), crush injuries (25. 3%), sharp injuries (including spaghetti wrists) (19%) machine mangling (11%), burns (8.4%), blunt injuries (15%), human bites (2.1%), snake bite (1.1%), gunshot (4.2%), and injection injuries (2.1%). Patients’ occupations were: farmers 23%, mechanics (20%), traders (11%), factory workers (5%), followed by 2% each of teachers, electricians and civil servants, and 1% each of drivers and pastors; 5% were unemployed. Ofthe remainder, 16 % were children and 11% students. Surgical procedures performed were groin flap (30%), exploration and repair (24%), skin grafting (21%), debridement alone (13%) cross finger flap (7%). decompression of carpal tunnel,(3%) and terminalisation(2%)Conclusion: Severe hand injuries requiring reconstructive surgery were sustained through road traffic accidents Farmers, traders, mechanics and children are at risk of severe combined hand injuries.

Graft reposition flap for fingertip injuries

We report our technique, graft reposition flap for fingertip injuries with bone and nailbed loss. We reconstructed Allen's IV fingertip amputations in 25 patients between 2015 and 2019. The graft reposition flap technique involves reattaching the amputated stump (distal phalanx, free nailbed graft) with Kirschner wire. In addition, we reconstructed the volar defect with cross finger flap, thenar flaps, first dorsal metacarpal artery-based flap, volar V–Y advancement flap, and antegrade homodigital flaps. The mean follow-up was 25 months. (Range, 12–36 months). We classified the results based on nail aesthetics, finger length, pulp pad, bone consolidation, cosmesis, sensation, pain, range of motion, grip strength, and return to work. Excellent or good results were achieved in 20 cases. Three cases had fair results, and 1 had poor results. We observed partial flap necrosis (n = 1), exposure of distal phalanx (n = 1), hook nail (n = 1) and absent nail (n = 1) This method is simple, reliable, and effective for restoring Allen's type IV fingertip amputation. This technique can be performed efficiently by surgeons in rural and urban hospitals lacking microsurgical expertise. It is an excellent alternative option for replantation. • Graft reposition is reattaching the amputated distal phalanx, nailbed graft. • Reconstructing the volar defect with a pedicled flap. • It is simple, and reliable method for Allen type IV amputations. • It restores the finger function and appearance. • It also restores finger length and sensation.

Study on clinical characteristics and outcome evaluation of cross finger flap in soft tissue defect of finger at Can Tho Central General Hospital

Background: Fingers and hand are important parts of human body and soft tissue defect of fingers are the most common form of hand injuries. There are various techniques used for reconstruction of finger defect but cross finger flap is effective and very simple procedure without significant complication or require special techniques. Objectives: To examine characteristics of clinical and to evaluate the outcomes of cross finger flap for reconstruction of soft tissue defect of fingers. Materials and methods: 22 patients who had soft tissue defect of fingers who had undergone the cross finger flap cover. We noted mechanism of injury, size of defect, size of the flap, type of cross finger flap was used. Outcome measures recorded were flap viability, flap sensibility using two -point discrimination (TPD), total active motion of fingers (TAM) and patient satisfaction.
 Results: Among 22 patients treated with cross finger flap, there were 18 men and 4 women with the average age 38.6±11.4. The most common mode of injury was industrial accident (59.1%). The mean size of the defect was 205.5±86.6mm2 (range: 110mm2-500mm2). The average TPD test measured was 7.6±1.5mm. Full range of motion was obtained in 81.8% of patients. The functional and aesthetic results were satisfactory in 95.5% patients. Conclusion: The cross finger flap is safe and effective method for reconstruction of soft tissue defect of finger. This procedure is simple to perform under local anesthesia and is able to provide both mechanical stability & sensory recovery.

A Comparative Study of Cross Finger Flap with Thenar Flap for Finger Tip Reconstruction

Introduction: Fingertip injuries are common hand injuries ranging from simple laceration to larger defects with amputations. Different methods are used to reconstruct the affected finger. Cross finger flaps and thenar flaps are commonly used but it is difficult to select among these two flaps to reconstruct the finger in our settings.
 Method: This is a time-bound prospective comparative study conducted in 14 months duration. The aesthetic (sensibility, appearance and function as subjective assessment) and functional outcomes (2 point discrimination and range of motion) were measured. Data were analyzed using SPSS version 21. Overall significance level was maintained at ‘p’ value < 0.05.
 Results: There was female predisposition with average age of 34.66 years. The common mode of injury was crush injury with right hand most commonly involved hand and middle finger being commonly injured digit. On subjective assessment, the difference on rating scale on sensibility, function and appearance was not statistically significant among two groups. There were statistical significant differences in mean of static and moving 2 point discrimination among thenar flap and cross finger flap. . The mean active range of motion at three types of joint (MP, PIP, DIP) of finger were 97.660, 82.660 and 38.660 in thenar group and 88.330, 78.660 and 33.660 in cross finger group respectively which were not statistically significant.
 Conclusion: Our study does not find any precise characteristics for the selection of thenar and cross finger flap based on aesthetic and functional outcomes in reconstruction of fingertip injury.

Local or distal flap in the management of digital trauma in children.

Objectives:We aim to describe the management of fingertip injuries treated by flaps in the paediatric surgery emergency ward and evaluate the long-term results.Patients and Methods:Through a 2-year prospective study, we analysed all fingertip injuries treated by flaps in the paediatric emergency ward. We collected patients' data and the clinical and imaging characteristics of the lesions. The type of flap was chosen on a case-by-case basis. We evaluated aesthetic and functional results.Results:Forty-two fingertip injuries required the use of flaps. The average age was 7 years, and boys were more affected. The smashed fingertip was the most common mechanism; pulp lesions and amputation were located mainly in zone I or II. We performed Atasoy flaps, palm flap, free skin grafts, McGregor flap and the cross finger flap. Our results were good to excellent in 66.67%.Conclusions:The best management of fingertip injuries in children remains prevention.

Study of soft tissue reconstruction in postburn flexion contracture of the hand

Background: Burn contracture of the hand can leave patients with severe functional and psychological limitations. This study evaluates the severity of the deformity and various reconstructive options in post-burn hand injuries.Methods: This work includes the study of 50 patients who underwent reconstruction for post-burn flexion contracture of the hand, including fingers, in the department of plastic surgery. The patients were treated between April 2007 to April 2009.Results: Males were more commonly affected by burn injuries and thermal burns were more common than electrical burns. The little finger showed higher involvement and contracture release followed by grafting was the commonly done reconstructive procedure.Conclusions: Split thickness skin graft (SSG) were more effective in reconstruction in thermal injuries, while cross finger flaps (CFF) showed more promise in electrical injuries of the hand.