Homodigital Neurovascular Island Flap Research Articles

Les lambeaux d’avancement en ilot pulpaire homodactyle des doigts longs. À propos de 32 cas

Aim Evaluation of reconstruction results using a homodigital neurovascular island flap so as to recover long fingers loss fingertip. Patients and methods This was a retrospective study of 32 fingertip-flaps of long fingers practiced on 31 patients. They were young people (mean age: 28 years), often male (77.5%), and manual workers in 55%. The loss fingertip was traumatic in 87%. The fingertip reconstruction has been urgently assured, except in three initially-treated whitlow cases. Results Four criteria value were used to value the results of coverage: Aesthetic, sensitive, functional, and socio-professional. We obtained good results in 72%. Conclusion The homodigital neurovascular island flap is a simple and reproducible technique. It's an excellent method for fingertip reconstruction in Allen type II and III. Despite of some complications, in touch with the initial trauma, this surgery gives back a useful sensitivity and a good aesthetic aspect of the fingertip.

The Spiral Flap for Fingertip Resurfacing: Short-Term and Long-Term Results

We describe a homodigital neurovascular island flap for reconstructing large pulp defects of the fingertips and review the short-term and long-term appearance and function of the reconstructed fingertips. The spiral flap is a homodigital neurovascular island flap with a unique spiral advancement and transposition design that allows pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. Thirty-two fingertips were resurfaced using this flap. All had large pulp defects averaging 1.2 cm wide x 2.0 cm long (1.0-2.0 cm x 1.5-2.5 cm). Short-term results (<18 months) for all patients at a minimum of 6 months and long-term results (>5 years) for 10 patients with a mean follow-up of 13 years were reviewed. Objective outcome measures included static 2-point discrimination, degree of nail deformity (beaking), total active motion, and hypersensitivity or cold intolerance. Subjective outcome measures included patient satisfaction with function and aesthetics, using a visual analog scale. All flaps achieved primary healing with no complications. There was initially mild extension deficit in the proximal interphalangeal and distal interphalangeal joints, which improved to full range of motion in the long term. Sensory recovery was excellent, with an average 2-point discrimination of 5 mm initially, improving to 4 mm in the long term. Nail beaking was minimal initially but increased significantly in the long term. These results may be explained by soft tissue remodeling. All patients on long-term follow-up were highly satisfied with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance at either the short-term or long-term follow-up assessments. The spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term and long-term functional and aesthetic results and high patient satisfaction. Therapeutic IV.

Restoration of Function and Sensitivity Utilizing a Homodigital Neurovascular Island Flap After Amputation Injuries of the Fingertip

Restoration of Function and Sensitivity Utilizing a Homodigital Neurovascular Island Flap After Amputation Injuries of the Fingertip

Restoration of Function and Sensitivity Utilizing a homodigital Neurovascular Island Flap after Amputation Injuries of the Fingertip

Sixty-three fingertip amputations in 50 patients were reconstructed using a homodigital neurovascular island flap technique based on a single neurovascular pedicle without further shortening of the distal phalanx. The procedure was carried out under regional anaesthesia, using a tourniquet and magnifying loupes. All of the flaps survived and achieved normal or adequate two-point discrimination without any painful scar or cold hypersensitivity. Fifteen patients had some loss of distal interphalangeal joint extension. The technique is simple and presents an excellent method for fingertip reconstruction in Allen type II, III and IV injuries.

Lateral-dorsal neurovascular island flaps for pulp reconstruction.

Finger pulp loss is often observed in daily practice. When the lateral and dorsal surfaces of the injured digit remain intact, a neurovascular island flap can be designed and raised from that part of the finger for pulp reconstruction. Two types of homodigital lateral-dorsal neurovascular island flaps were used in 17 patients (13 type I and 4 type II) for reconstruction of traumatic pulp loss on an emergent basis. The type I flap was used for the pulp defect less than 2.5 cm in length; the type II flap was designed for extensive pulp loss. The size of the pulp defect varied from 1.7 x 1.2 cm to 3.8 x 1.7 cm. All flaps survived completely without any partial loss. The mean follow-up was 17.7 months. The mean static two-point discrimination was 5.2 mm in type I flaps and 9.3 mm in type II flaps. All patients except five had full range of motion of the interphalangeal joint. These five patients (3 type I and 2 type II) had 10 to 20 deg reduction in flexion of the distal interphalangeal joints. The homodigital lateral-dorsal neurovascular island flap offers a durable, well-vascularized, sensate skin flap for one-stage pulp reconstruction in select patients. This technique is relatively simple, allows early postoperative mobilization, and has an acceptable surgical outcome.

Fingertip Reconstruction Using Two Variations of Direct-Flow Homodigital Neurovascular Island Flaps

The fingertip is an extremely intricate area of digital sensibility that plays an important role in fine perception and hand function. Thus, sensate fingertip reconstruction is essential to the recovery of most hand functions. The authors used two methods of direct-flow homodigital neurovascular island flap coverage to reconstruct distal finger amputations-namely, the triangular-advancement flap technique and the step-advancement flap method. The authors present their experience with these two variations of direct-flow homodigital neurovascular island flaps and their use in reconstructing 18 fingertips and 7 proximal amputation stumps. They did not observe flap failure, and they achieved stable, well-vascularized, appropriate-thickness skin coverage with good sensory properties in all patients. However, they found that the triangular-advancement flap technique was easier to plan and perform than the step-advancement method.

Homodigital neurovascular island flaps with "direct flow" vascularization.

Pulp loss of the fingers is frequently observed. When local advancement flaps are not sufficient to repair the defect, the homodigital monopedicled island flaps with "direct flow" are a simple and current reconstructive solution. Between 1991 and 1995, 32 homodigital neurovascular direct flow island flaps were performed for fingertip defects. We used a modified triangular Venkataswami flap for oblique amputations (26 patients) and the Mouchet-Gilbert island flap for tangential defects (6 patients). Our results (with excellent skin quality and good sensory recovery) lead us to consider these flaps as the first-choice reconstructive solution in patients with extensive but not complete pulp defects (< 2 cm) of the fingers.

指尖部損傷に対する治療法の検討

We evaluated the prognoses of finger tip injury cases using a post card questionnaire to estimate the sensitivity of the stump, their status on daily use external appearance and the patients satisfaction with the treatment.Twenty-one (70%) of 30 patients replied to the questions naire. Eleven had been treated conservatively (using aluminium foil), 5 had stump plasties and 5 had homodigital neuro-vascular island flaps (modified Kutler's method). The follow-up periods were 2 years and 4 months, 3 years and 1 month, 2 years and 8 months respectively.Regarding sensation, the conservative group was superior to other groups, and all stump plasty cases complained of paresthesia or hypesthesia on their stumps.In regard to the daily use and appearance, there were no remarkable differences between the groups.No patients complained of being dissatisfied with the results.

Homodigital neurovascular island flaps for digital pulp loss

Terminal amputations with loss of the distal pulp are common injuries. This report analyses 64 consecutive cases of advanced or exchanged homodigital neurovascular island flaps operated on by one surgeon between 1981–1986. The surgical technique, indications, contra-indications and five year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the finger where high quality perception is required.

Homodigital neurovascular island flaps for digital pulp loss.

Terminal amputations with loss of the distal pulp are common injuries. This report analyses 64 consecutive cases of advanced or exchanged homodigital neurovascular island flaps operated on by one surgeon between 1981-1986. The surgical technique, indications, contra-indications and five year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the finger where high quality perception is required.

Homodigital neurovascular island flaps in hand surgery. A study of sixty cases. (French and English)

Homodigital neurovascular island flaps in hand surgery. A study of sixty cases. (French and English)

Restauration pulpaire par lambeau neurovasculaire homodigital

A homodigital neurovascular island flap was used to cover extensive loss of finger tip tissue exposing the distal phalanx in twenty cases (16 adults and 3 children). The anatomic and technical aspects of this flap are detailed. In all cases, the reconstructions were considered to be of excellent quality. The study of functional results substantiates the reliability of this island flap, for which sensibility remained good throughout the follow-up period.