Reconstruction Of Fingertip Defects Research Articles

Composite classification and algorithmic reconstruction of fingertip defects with free lateral great toe flaps

This study aimed to classify fingertip defects according to dimensions and composite content, and present algorithmic reconstruction results with free lateral great-toe flaps. A total of 33 patients who underwent reconstruction for full-thickness defects of fingertips with free lateral great-toe flaps were retrospectively reviewed. Patients were divided into four groups by the algorithm according to the dimension and content of defects. Functional disabilities of the upper extremities, limitations of donor feet, finger cosmetics, sensory recovery, and pinch power were evaluated using the disabilities of the arm, shoulder and hand, foot function index, 5-point Likert satisfaction scales, Semmes-Weinstein monofilament and static 2-point discrimination tests, and pulp pinch-strength test, respectively. The standardized distribution of patients according to dimensions and content of defects was achieved. When the composite content of defects increase such as group 4, complex surgical skills are required, duration of surgery is extended, return to work is delayed, and donor-site complications are increased. Functional limitations of the hands improved normally after reconstruction (p<0.00). Sensory recovery of flaps was normal and test scores were strongly correlated (p=0.78). All patients and observers were satisfied with finger's cosmetics. Our classification and reconstruction algorithm is simple and easy to apply for all fingertip defects without complicated reference points, and it provides information about the surgical and post-surgical periods. When the dimension and composite deformities of the defect increase through groups 1-4, more complex reconstruction, increased donor-site complications, prolonged duration of surgery, and delayed return to work are observed.

A dorsalis pedis venous flap containing a U-shaped venous arch for the reconstruction of fingertip defects.

In small-area soft tissue defects of the fingers, venous flaps have the advantages of easy design and harvesting, and also a thin and flexible texture. Although the artery-vein-vein (A-V-V) pattern is the safest pattern, the tiny veins in the finger pulp make anastomosis difficult. We have designed a modified blood flow pattern flap using the dorsum of the foot as the donor site and anastomosing the U-shaped blood vessels in the venous flap with the two digital arteries in an artery-vein-artery (A-V-A) pattern to reconstruct the digital arterial arch without the need for venous anastomosis. Our study included 22 patients with 23 fingertip defects. In the 23 fingers, 18 flaps survived completely and four had only partial marginal necrosis. The donor site healed well without significant scar hyperplasia.Level of evidence: IV.

Comparison of Clinical Outcomes of Heterodigital Neurovascular Island Flap, Reverse Homodigital Neurovascular Island Flap, and Cross-Finger Flap Used for Fingertip Reconstruction.

The fundamentals of fingertip defect reconstructions should be mainly to restore the sensation with contour and identical pulp volume, and texture. To achieve these, various flap techniques were described in which those had their own advantages and disadvantages to restore the fingertip injuries. This study aimed to compare clinical outcomes of three different local flap procedures widely used for the reconstruction of fingertip defects: heterodigital neurovascular island (HeNI) flap, reverse homodigital neurovascular island (rHoNI) flap, and cross-finger (CF) flap. Between 2014 and 2019, statistical analysis of 58 patients undergoing reconstruction of fingertip defects of 2-5 digits by HeNI flap (n = 16), rHoNI flap (n = 17), or CF flap (n = 25), was performed retrospectively. All cases were reviewed regarding age, gender, etiology of trauma, duration of follow-up, the extent of the injury with the classification system PNB, Quick Disability of Arm, Shoulder, and Hand score (Q-DASH), cold intolerance symptom severity score (CISS), static 2-point discrimination test, ROM value of phalangeal joints and time to return to work. The mean age of all patients was 36.9years with a male-to-female ratio of 5.4:1 and a mean follow-up of 26.72months. The most common cause was work-related (n = 41). The mean of DASH score, CISS score, static 2-point discrimination, time to return to work, and ROM value of DIP joint did not significantly differ between the study groups. The mean ROM values of PIP and MCP joints of patients for CF flaps applied were significantly lower than HeNI flaps. The use of HeNI flap for fingertip reconstruction is a reliable one-stage option in terms of improved ROM of finger joints.

Digital Artery Perforator Flap Use in Reconstruction of Fingertip Defects

Amac: Parmak ucu defektlerinin rekonstruksiyonunda dijital arter perforator flebi kullanarak yapilanrekonstruksiyonlar ile ilgili deneyimimizi bildirmeyi amacladik. Gerec ve Yontem: Parmak defektleri nedeniyle ameliyat edilenve dijital arter perforator flep ile rekonstruksiyon yapilan 8 hasta calismaya dahil edildi. Hastalar etyoloji, cinsiyet, yas, komorbidite ve sonuclar acisindan degerlendirildi. Fleplerin boyutlari 20 x10 mm ile 25 x20 mm arasindaydi. Bulgular: Hastalarin ortalama yasi 43,6 ( 19-66) idi. 8 flebin 6'si tam olarak sag kaldi ve sorunsuz iyilesti. Bir flepte kismi cilt nekrozu yasanirken 1 flep ise tamamen kaybedildi. Hicbir hasta soguk intoleransindan veya eklem kontrakturunden sikayetci degildi. Hastalardan birinde hafif tirnak deformitesi olustu. Sonuc: Dijital arter perforator flebi(DAPF), komorbiditesi olmayan ve sigara icmeyen hastalarda parmak ucu defekti rekonstruksiyonlari icin guvenilir ve cok yonlu bir fleptir. Tek asamali ameliyat proseduru, flebi hazirlama kolayligi, hizli iyilesme ve dijital arterlerin korunmasi en onemli avantajlaridir.

Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator

Background. The hand is the most frequently injured body part. Injuries to the fingertips are among the most common hand injuries. In this article an anterograde pedicle flap based on the dorsal branches of proper digital artery from the dorsum of the middle phalanx was used to reconstruct the fingertip defect as described by Peng Wei MD in a single stage to provide a durable, sensate coverage with the least possible complications. Aim of study. To introduce and assess the result and long term follow up of using an anterograde pedicle flap based on the dorsal branches of proper digital artery from the dorsum of middle phalanx. Patients and method. A total of twelve male patients were presented to us between November 2016 and January 2018. All of them had history of fingertip injuries and had undergone reconstruction using anterograde pedicle flap based on the dorsal branches of proper digital artery from the dorsum of the middle phalanx” the period of follow up ranged from one month to six months with an average of three months. Result. In this study 12 patients presented with fingertip defect were surgically treated by using an anterograde pedicle flap based on the dorsal perforator. All the patient had satisfactory result with good pliable contour coverage of their injured fingertip with no restriction of finger movements. Conclusion. The use of anterograde island flap based on the dorsal branches of proper digital artery from the dorsum of middle phalanx is suitable for reconstruction of fingertip defects of various amputation planes, it provided good contour texture with preservation of digital artery and nerve, it also provides patient with acceptable fingertip appearance.One of the major drawbacks of this procedure is that it requires tedious and meticulous dissection and that donor site requires full-thickness skin graft, which leads to donor site morbidity and scarring. Keywords.

Modified method of Hallux toe nail flap for finger tip reconstruction and donor site repair

Objective To discuss the modified method and clinical effect of free hallux toe nail flap for reconstruction of composite tissue defect at finger tip and repair of its donor site. Methods Partial nail bed at fibular side of hallux was cut and combined with toe tip skin to form hallux toe nail flap. The reconstruction of finger tip defects was achieved by free hallux toe nail flap transplantation. The donor site of hallux was sutured directly. Nail bed wound was healed by itself without skin graft or flap repair. From May 2013 to April 2015, 13 cases (15 fingers) had partial nail bed and skin defects at finger tip and no obvious distal phalanx defects, which were repaired by this method. Results All the patients were follow-up for 3 to 12 months. All the free hallux toe nail flap graft survived. The finger tip appearance and nail growth were close to normal. The function of interphalangeal joint was good. Hallux nail was nearly complete with good appearance and without obvious defect. No local pain, ulceration, and sensory disorder occurred at hallux donor site. Conclusion Hallux toe nail flap is an ideal method for reconstruction of composite tissue defect at finger tip. The improvement of donor site repair method can make better appearance of toe tip and nail without obvious sequelae. Key words: Finger injuries; Surgical flaps; Free tissue flaps; Fingertip defects

Super Kutler flap: an alternative technique for reconstruction of fingertip defects.

IV.

Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator.

Background:The purposes of this article are to introduce and assess the results of a long-term follow-up of using anterograde pedicle flap based on the dorsal branches of proper digital neurovascular bundles from the dorsum of the middle phalanx for the fingertip defect.Methods:Between February 2011 and December 2012, 31 patients underwent reconstruction of fingertip defects using a homodigital flap based on the dorsal perforator in the middle phalanx. The defect size ranged from 1.3 cm × 1.5 cm to 2.4 cm × 3.0 cm. During surgery, the flap was designed on the dorsal middle phalangeal region. The pedicle was a neurovascular bundle consisting of an artery, vein, and sensory nerve; the rotation of pedicle was <90 degrees.Results:The clinical results were satisfactory after 3 to 9 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The sensory recovery was excellent, 2-point discrimination was 4.96 ± 1.47 mm, and the recovery of range of motion of the interphalangeal joints was very good.Conclusions:The anterograde island flap based on the dorsal branches of proper digital neurovascular bundles is an ideal aesthetic reconstruction method for fingertip defect. A 90-degree rotated island pedicle flap was very versatile, easy to design, and had good survival. This technique is simple with less damage to the donor site, without sacrificing the branch of the digital artery and nerve. The reliable source of blood supply and satisfactory recovery of sensation can be achieved without affecting the interphalangeal joint activity.

Reconstruction of fingertip defects with digital artery perforator flap.

The aim of this study was to present our findings for the use of the digital artery perforator (DAP) flap in the covering of digital pulp defects. The study included 15 patients who underwent reconstruction of the fingertip using a DAP flap between July 2007 and February 2012. The blood supply of the perforator island flap was based on the distal and either radial or ulnar sides of the digit. Donor sites were closed using skin grafting in all cases. Static two-point discrimination (s2PD) and Semmes-Weinstein monofilament (SWM) testing was performed at the final follow-up to determine extension loss and sensorial improvement. Mean follow-up was 22 (range: 7 to 62) months. Flaps size was between 2 x 1 cm and 2.5 x 1.5 cm. Temporary venous congestion was observed in 12 of the 15 patients and was without complication. All patients returned to their normal daily activities and work within an average of 39 (range: 30 to 45) days. Mean two-point discrimination was 5.3 mm and SWM test results were between 3.61 and 4.56 at the final follow-up. The DAP flap appears to be a reliable procedure with several advantages as a single-stage operating procedure, easy to harvest, good sensory recovery and preservation of digital arteries.

Our Principles for Reconstruction of Fingertip Defects

Our Principles for Reconstruction of Fingertip Defects

Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects.

Background:Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.Materials and Methods:Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.Results:Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.Conclusion:Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

Fingertip reconstruction using the hypothenar perforator free flap

The purpose of this study was to present the results of using the hypothenar perforator free flap for fingertip reconstruction. Between 2004 and 2012, 24 patients underwent reconstruction of fingertip defects using the hypothenar perforator free flap at our institute. Flap survival was complete in 22 flaps. Flap size ranged from 1.5 to 2.5cm in width and 2.7-4.5cm in length. Donor sites were closed primarily in all patients. Healing of all donor sites was uncomplicated, and donor-site morbidity was minimal with acceptable scarring. Long-term follow-up for more than 12 months (range, 12-51 months) was possible in 14 patients and revealed excellent flap sensibility. The hypothenar perforator free flap provides acceptable functional and cosmetic outcomes for the reconstruction of fingertip defects. The authors recommend that this flap should be considered as a useful option for fingertip reconstruction.

Bilateral digital neurovascular advancement flap to repair fingertip defects

Objective To investigate the clinical effects of bilateral digital neurovascular advancement flap for repair of soft tissue defects of the fingertip.Methods From January 2010 to October 2011,9 cases of fingertip defects were treated with bilateral digital neurovascular advancement flap from the same finger.The defect sizes ranged from 2.0 cm× 1.8 cm to 1.5 cm × 1.5 cm.Results All 9 flaps survived after the operation.These cases were follow-up for 14 to 20 months,16 months on average.The flaps had good appearance and fingertips were full.There was no hooked nail deformity and tenderness of the scar in the pulp.Two-point discrimination was 3 to 5 mm.Sweating was normal.The function of finger motion returned to 0° to 60°.According to the upper limb function assessment criteria issued by the Chinese Hand Surgery Society,the results of the 9 cases were graded as excellent.Conclusion Transfer of bilateral digital neurovascular advancement flap for reconstruction of fingertip defect is a simple and ideal method for reconstruction of thumb or finger tip defects with satisfactory clinical results. Key words: Finger injuries; Surgical flaps; Repair

Reconstruction of a fingertip with a thenar perforator island flap

We raised thenar island flaps that were supplied by perforators that originated in the superficial palmar arch or the superficial palmar branch of the radial artery for the reconstruction of fingertip defects in eight patients. The flap was so well-vascularised that a large flap with increased mobility could be raised. The donor site was covered with well-vascularised thick tissue, and skin grafting of the donor site was avoided in all cases. No patient developed a complication, and all flaps survived. Functional and cosmetic results of both fingertips and donor sites were excellent. A perforator island flap from the thenar eminence can be raised easily without injuring any digital and palmar arteries. They have a good colour and texture that matches the fingertips and donor site defects on the palm.

Versatility of a Second Toe Plantar Flap

A second toe plantar flap was first reported about ten years ago as a useful small neurocutaneous flap for reconstruction of fingertip defects. Since that time, a satisfactory follow-up report on this noteworthy procedure has not yet appeared. In this article, the advantages and potentialities of the flap are discussed along with the pitfalls of clinical application. Two types of reconstruction have been performed using this flap during the past eight years. One type, which has been used in 12 cases, involves combination with an onychocutaneous flap. The other type, which has been used in 15 cases, involves sole transfers to distal digital defects or secondary defects of the palmer side of the digits after releasing the contracture, which is assessed functionally and esthetically. Thirteen of these 27 reconstructions were conducted uneventfully; however, two cases of arterial insufficiency at the donor toe were experienced. Functional and esthetic evaluations of these thirteen cases were almost acceptable, and the donor toe complication was also considered to be a minimum adverse effect. This flap is suitable for not only a distal palmer defect, but also variously shaped skin defects of the digits with minimum donor site morbidity; however, the possibility of arterial insufficiency of the pedicle should be borne in mind.

The Subcutaneous Pulp Flap for Fingertip Defects

Various reconstruction procedures are now available for the treatment of fingertip defects with exposure of the phalanx. Herein we report a subcutaneous pulp flap (SPF) technique, involving use of the adjacent fatty tissue of the wound to form a rotated fatty tissue flap that covers the exposed bone. The SPF was then treated postoperatively with repeated moist dressings. This SPF treatment had minimal donor site defect and morbidity. In brief, the technique is a simple and safe alternative for the reconstruction of fingertip defects. The shortcoming of this flap is that the healing period is longer than for other methods.

Reconstruction of fingertip defects with the neurovascular tranquilli-leali flap

For many years, bipedicled palmar advancement flaps were used rarely in fingers because they sacrificed the dorsal branches of the digital arteries, risking dorsal skin necrosis. In 1995, a short bipedicled neurovascular VY advancement flap raised distally to the PIP flexion crease, which spared the dorsal blood supply, was described by Elliot et al. (1995). This paper includes an anatomical study on 28 fresh cadaver fingers to evaluate the advancement potential of this flap. It also reviews 22 fingertip reconstructions in 22 patients using this flap. The mean advancement of the flap in the cadaver study was 14 (range 10-16) mm. This procedure gave good clinical results in respect of healing, sensibility, bone cover and appearance. Complications occurred in four fingers (18%), viz. two infections, one neuroma and one stiff proximal interphalangeal joint. Our study suggests that this flap can be used to treat fingertip defects of a size of approximately half of the pulp of the distal phalangeal segment of the finger.

Reverse flow sensate digital artery island flep in reconstruction of finger-tip defects

Reverse flow sensate digital artery island flep in reconstruction of finger-tip defects