Reverse Digital Artery Island Flap Research Articles

Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective cohort study

BackgroundReverse homodigital artery island flap (RHDI) has reported some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been performed to decrease these complications. This study aimed to provide a review of the CRDI procedure and to compare the clinical outcomes of CRDI with RHDI. MethodsRHDI has been performed for fingertip amputations with the deficit of 1.5–2.5cm before 2018, and CRDI has been performed since 2018. We assessed functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. ResultsWe identified 22 patients who underwent RHDI and ten patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing in RHDI was 47.0 days (IQR: 34.3–55.8), and that in CRDI was 34.5 days (IQR: 29.3–44.3). The hook nail deformity occurred significantly more frequently in RHDI compared to in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found significantly more in RHDI than in CRDI (36.4% vs. 0,0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260º–280º). The median postoperative Hand20 scores were similar between the two groups. ConclusionCRDI was associated with superior clinical outcomes in terms of lower rate of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.

Comment on “Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective study” and a focus on hook nail deformity

Comment on “Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective study” and a focus on hook nail deformity

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve.

To illustrate the clinical outcomes of the reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defects. From December 2007 to December 2017, a total of 20 patients with finger pulp defects were treated with reverse digital proper artery island flap for innervated construction. Functional outcomes, aesthetic appearance, and complications were evaluated. Functional outcomes were assessed according to range of motion, sensory grade (S0-S4), static 2-point discrimination, Semmes-Weinstein monofilament test, and Cold Intolerance Severity Score. Aesthetic appearance was evaluated according to the Michigan Hand Outcomes Questionnaire. All flaps survived completely without any complications, and all patients were followed up for at least 12 months. The average static 2-point discrimination, Semmes-Weinstein monofilament, and Cold Intolerance Severity Score results of the injured fingers were 6.35 mm (range, 5-8 mm), 3.64 (range, 2.83-4.17), and 19 (range, 8-24), respectively. All patients achieved recovery in sensation from S3+ to S4. The active ranges of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the affected fingers were satisfactory. Based on the Michigan Hand Outcomes Questionnaire, 11 patients were strongly satisfied, and 9 were satisfied with the appearance of the injured finger. The reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve is an effective and reliable alternative for the reconstruction of finger pulp defect. In the recovery of sensation, this flap leads to satisfactory effects.

Repair of fingertip defect with reverse digital artery island flap and repair of donor site with digital dorsal advancement flap.

The reverse digital artery island flap (RDAF) is widely used in repairing fingertip skin defects based on its good appearance and practicability. However, the donor area of the flap needs skin grafting, which can lead to complications. This retrospective study explored the clinical application of digital dorsal advance flap (DDAF) in repairing the donor site of the reverse digital artery island flap. From June 2019 to February 2022, 17 patients with a soft tissue defect of the finger had been restored with the reverse digital artery island flap, and at the same time, the donor area was repaired with digital dorsal advance flap (DDAF). The sensitivity, the active range of motion (ROM) and patient satisfaction were assessed after the operation. All flaps survived completely without skin grafting with only one linear scar. The sensory and motor functions of all patients recovered well. Assessment based on the Michigan Hand Outcomes Questionnaire (MHQ) showed satisfactory functional recovery for all patients. Reconstruction using RDAF combined with DDAF represents an effective alternative for repairing fingertip skin defects.

Reverse digital artery island flap with versus without sensory nerve coaptation for finger pulp reconstruction.

Whether an innervated reverse digital artery island flap is superior to a non-innervated reverse digital artery island flap still remains controversial. We aimed to compare the clinical outcomes of the two flaps in repairing finger pulp soft tissue defects. Medical records of patients who underwent finger pulp reconstruction between January 2007 and December 2017 were evaluated retrospectively. A total of 45 patients were included. Twenty underwent sensory nerve reconstruction with cutaneous branches of the proper digital nerve, and 25 underwent the surgery without sensory nerve reconstruction. Surgical results, complications and sensory function were collected for analysis. Sensory function was assessed by static two-point discrimination and the modified sensory evaluation standard of British Medical Research Council. The average operation time of innervated flaps was 23 min longer than non-innervated flaps. All 45 flaps survived completely. There was no significant difference in complications between groups. The average follow-up was 22 months. At the final follow-up, five non-innervated flaps had no recovery of static two-point discrimination. The average static two-point discrimination of the remaining 20 non-innervated flaps was larger than that of innervated flaps. Innervated flaps consistently achieved higher sensory function grades according to the modified sensory evaluation standard of British Medical Research Council. An innervated reverse digital artery island flap can achieve better sensory function recovery in a shorter time. This procedure did not increase the incidence of complications, although it extended the operation time. It has proven to be a good technique for finger pulp reconstruction.

Clinical Application of a Modified Local Transposition Flap (Parallelogram Flap) Surgery in Repairing Fingertip Defects.

Parallelogram flap was performed for transverse finger amputation with the loss of distal pulp, nails, and bone. This study aimed to compare the clinical effects of parallelogram flap, antegrade homodigital island flaps, and reverse digital artery island flaps in fingertip reconstruction. From January 2017 to January 2021, clinical patient data with parallelogram flaps (78 cases), antegrade homodigital island flaps (78 cases), and reverse digital artery island flaps (78 cases) to repair fingertip defects were collected and analyzed. Two hundred thirty-four cases (234 fingers) were included in our study. All operations were performed by one surgical team. The operation time, 2-point discrimination, total active movement, and the Michigan Hand Questionnaire (MHQ) of the injured fingers were recorded to evaluate the therapeutic effect. Parallelogram flaps (group A), antegrade homodigital island flaps (group B), and reverse digital artery island flaps (group C) had survived postoperatively. The operative duration of group A is the shortest (A < B < C, P < 0.05). At the last 6-month follow-up, there was no difference with the 2-point discrimination of the palmar part of the flaps in group A and group B but better than group C (P < 0.05). There was no difference with the total active movement of injured figures in 3 groups (P > 0.05). The MHQ summary scores in group A were much higher than those in group B and group C (P < 0.05). Evaluation of the MHQ subscale performance showed that the overall hand function, activities of daily living, work performance, and pain score had no differences (P > 0.05), but aesthetics and satisfaction score was the highest in group A (A > B > C, P < 0.05). The reconstruction of transverse finger amputation using parallelogram flaps can achieve a shorter operation time, a more satisfying appearance. Parallelogram flaps and antegrade homodigital island flaps can both achieve a better sensory recovery. Parallelogram flaps is a better choice for reconstruction of transverse finger amputation with the loss of distal pulp, nails, and bone.

Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap.

This study aimed to compare the outcomes of reverse digital artery island flap (RDAIF) in primary and secondary reconstruction after failed replantation or composite graft method. This study retrospectively analyzed 42 patients that underwent RDAIF (18 primary and 24 secondary). Preoperative details (demographics, injury details, and waiting days) and postoperative outcomes (active arc of proximal interphalangeal [PIP] and distal interphalangeal (DIP) joints, extension loss of PIP, flexion arc of metacarpophalangeal joint, total active motion, flap sensation, the presence of numbness, Tinel's sign and cold intolerance) were evaluated. Quick Disabilities of the Arm, Shoulder, and Hand score (Quick-DASH) and patient satisfaction were also statistically compared between the 2 groups. There was no significant difference in patient demographics between the 2 groups in sex, age, smoking and diabetic history, affected hand and finger, injury type and level, and flap area. The only difference was in waiting days. Similar sensory recovery and patient satisfaction were found in both groups. Range of motion in the DIP and PIP joints, extension loss of PIP, total active motion, and Quick-DASH were superior in the primary coverage group. Increasing age, subzone III injury, and secondary reconstruction were found to be the factors that adversely affected the postoperative range of motion. Secondary reconstruction was more likely to result in joint contracture. In the event of a damaged fingertip amputation in older patients, primary flap reconstruction should be considered as the initial treatment of choice, with regard to the ultimate range of motion.

A Study on the Middle Transverse Palmar Arch: Preoperative Ultrasonography in Reverse Digital Artery Island Flap

A Study on the Middle Transverse Palmar Arch: Preoperative Ultrasonography in Reverse Digital Artery Island Flap

Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction.

This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction. We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated. The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications. The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.

Potential of Tissue-Engineered and Artificial Dermis Grafts for Fingertip Reconstruction.

Management of skin and soft-tissue defects of the fingertips is functionally and aesthetically important, but controversial, especially when bones are exposed. Recent advances in wound healing technology allow the use of cells or biological dermis. The authors studied the clinical efficacy of tissue-engineered dermis grafts and artificial dermis grafts versus immediate reconstructive procedures, such as the reverse digital artery island flap, in treating bone-exposed fingertip defects. One hundred eighty-two patients with bone-exposed fingertip defects treated with tissue-engineered dermis grafts (n = 71), artificial dermis grafts (n = 23), or reverse digital artery island flaps (n = 88) were included in this retrospective cohort study. Surgical time, duration of hospitalization, total cost, success rate, healing time, sensory recovery, range of motion, scar quality, and patient satisfaction were compared. No tissue-engineered or artificial dermis graft exhibited graft rejection or failure, whereas there was one partial loss and one total loss after reverse digital artery island flap surgery. Tissue-engineered dermis grafts were superior in scar quality, and artificial dermis grafts had shorter surgical times and lower surgical costs; both groups demonstrated superior results in postoperative range of motion and sensory recovery in two-point discrimination tests and shorter hospitalization, compared with the reverse digital artery island flap group. The reverse digital artery island flap had shorter complete closure time and less postoperative tingling sensation. There were no differences in overall patient satisfaction among the groups. Tissue-engineered and artificial dermis grafts may be promising alternatives for fingertip reconstruction. In particular, tissue-engineered dermis grafts may deliver superior functional results, including recovery of sensory discomfort and aesthetic results in terms of scar quality over artificial dermis grafts. Therapeutic, III.

Repair of donor site of reverse digital artery island flap with transverse V-Y fascial advancement flap of proximal dorsum of the finger

Objective To summarize the clinical efficacy of transverse V-Y fascial advancement flap of proximal dorsum of the finger for the repair of the donor site of reverse digital artery island flap. Methods From January 2017 to February 2018, 14 patients with fingertip defect were treated, including 4 emergency cases and 10 sub-emergency cases. The range of fingertip defect was 1.6 cm×0.6 cm to 2.5 cm×1.4 cm. The fingertip wound was repaired by reverse digital artery island flap and the donor site was covered by transverse V-Y fascial advancement flap of proximal dorsum of the finger. Results The flaps survived uneventfully after operation, and all the donor and recipient wounds achieved primary healing. The follow-up period ranged from 9 to 15 months with an average of 10.6 months. The skin flaps were of good texture, color, shape and no tenderness at the fingertips. At the last follow-up, the two-point discrimination of reverse digital artery island flaps was 7 to 12 mm, with an average of 8.6 mm. The two-point discrimination of V-Y advancement flaps of dorsal fingers was 5 to 9 mm, with an average of 6.2 mm. There was no web contracture, and the maximum abduction angle was 38° to 45° with an average of 42°. According to the total active range of motion (TAM) system, 12 cases were excellent and 2 cases were good. Conclusion The transverse V-Y fascial advancement flap of proximal dorsum of the finger was used to repair the donor site of reverse digital artery island flaps. The appearance, function and sensation of the fingers recovered well, and the related complications of free skin grafting were avoided. Key words: Finger injuries; Surgical flaps; Donor site; Wound repair

The web artery perforator pedicled propeller flap for covering donor site defect of reverse digital artery island flap

Objective To introduce the surgical techniques and clinical efficacy of repairing donor site defect of reverse digital artery island flap by the web artery perforator pedicled propeller flap. Methods Twelve cases with skin defects of the fingertips were treated with reverse digital artery island flaps transfer. Defects at the donor site were repaired with the web artery perforator pedicled propeller flap. The size of the digital artery island flaps ranged from 1.5 cm×2.0 cm to 2.0 cm×3.5 cm. The web artery perforator pedicled propeller flaps measured from 1.5 cm×2.0 cm to 2.0 cm×3.5 cm. Results All 24 flaps survived with primary wound healing. The patients were follow-up for 1 to 18 months. The appearance and texture of the perforator flaps were good. The width and depth of the web space were not affected. The abduction angle of the injured finger was close to normal. There were no complications such as scar contracture, tenderness, and nerve conduction abnormalities. Conclusion The web artery perforator pedicled propeller flap for covering donor site defect of reverse digital artery island flap is a safe and effective surgical technique. Its advantages include constant blood supply, simple operation, and fewer complications. Key words: Surgical flaps; Microsurgery; Web artery; Perforator pedicled propeller flap

Finger pulp reconstruction with innervated reverse digital artery flap through bilateral neurorrhaphy

Objective To investigate the clinical outcomes of finger pulp reconstruction with innervated reverse digital artery flap with the sensory nerve branches through bilateral neurorrhaphy. Methods From April 2014 to March 2015, innervated reverse digital artery flaps with the sensory branches of proper digital nerves were transferred to repair pulp defects of 17 fingers in 15 patients. The flap was designed at the lateral aspect of the proximal phalanx. Two branches of the proper digital nerve that projected towards the flap were included in the flap. After flap inset, these two branches were coapted with the stumps of the bilateral proper digital nerves. Results All the flaps and skin grafts survived uneventfully. These cases were follow-up for 7 to 11 months. The reconstructed pulps had good appearance and supple texture. There was no flap bulkiness or pigmentation. The involved fingers recovered normal active motion. The pain and temperature sensation were recovered in all the flaps. Static two-point discrimination value was 5 to 8 mm, while the average Semmes-Weinstein monofilament score was 3.22 to 3.84. The average Cold Intolerance Severity Score(CISS) was 23 (range, 11 to 44), with 15 patients corresponded to mild cold intolerance and 2 patients corresponded to moderate cold intolerance. According to the upper limb functional assessment criteria issued by the Chinese Hand Surgery Society, the results were rated as excellent in 14 fingers, good in 2 fingers, and fair in 1 finger. Conclusion Satisfactory appearance and sensation of finger pulp can be restored by transferring innervated reverse digital artery island flap with bilateral neurorrhaphy to the branches of the proper digital nerves. Key words: Surgical flaps; Finger injuries; Treatment outcome; Neurorrhaphy

Histological investigation of common insensate flaps obtained from the hand and forearm regions for use in fingertip reconstruction

Objective: Many skin flaps have been described for fingertip reconstruction; however, they have not been compared histologically. The aim of this study is to compare the histological features of common insensate flaps that are used for fingertip reconstruction.Method: Skin from fingertips and common flap donor sites on the hand and forearm of cadavers were harvested. This study investigated four histological characteristics, namely thickness of the epidermis and dermis; the ratio of collagen to elastic fibres (C/E ratio) in subdermal tissues, and distribution densities of Merkel cells and Meissner’s corpuscles. It then compared the values obtained to determine which flap donor site best matched the fingertip.Results: Epidermal thickness of the reverse digital artery island flap, thenar flap, and hypothenar flap was similar to that of fingertip tissue; dermal thickness of the hypothenar flap was similar to that of fingertip tissue. The C/E ratio of the reverse digital artery island flap was similar to that of fingertip tissue. Merkel cells were abundant in the reverse digital artery island flap, but Meissner’s corpuscles were few in each of the flaps compared with fingertip tissue.Conclusion: The flap donor site with histological properties most similar to fingertip tissue was the palmar lateral aspect at the finger base, representative of the reverse digital artery island flap with respect to epidermal thickness, C/E ratio, and presence of Merkel cells. The thenar and hypothenar flaps also showed similar properties.

Experience of Raising Flaps Using Cadavers Embalmed by Saturated Salt Solution Method

Sir: In plastic and reconstructive surgery, raising the flap is an important skill1; but sometimes it is difficult for young plastic surgeons to detect and isolate the vessels. However, only a few studies have focused on flap training using cadavers. In these studies, researchers used formalin fixation techniques, which produced tissues with rigidities too high to provide a realistic simulation of flap training.2 Therefore, preservation methods such as fresh cadaver3,4 and Thiel method2 have been favored. Fresh cadaveric tissue is a superior model of simulation because of its approximation of live tissue,4 but it has many disadvantages such as high cost, limited use, and risk of infection.1,2 Thiel-embalmed cadavers have life-like color and flexibility.2 However, Thiel method is quite complicated and requires the use of several problematic and expensive substances during its preservation process. In addition, Thiel-embalmed cadavers have their drawbacks: muscular disintegration and limited time for dissection.5 Recently, Hayashi et al5 reported that the cadavers embalmed by the saturated salt solution (SSS) method, which consisted of saturated sodium chloride, low-dose formaldehyde, phenol, glycerin, isopropyl alcohol, and water, were not less suitable than Thiel-embalmed cadavers in several skills training courses in acute care surgery. Therefore, the authors tried raising several flaps in the SSS-cadavers for future use in flap training. Four SSS-embalmed cadavers and 1 Thiel-embalmed cadaver were used for this study, and the procedures were performed in an anatomical training room at Tokyo Medical University. All procedures were performed by Takayuki Shirai (a plastic surgeon with 9 years of experience). The cadavers were used 1–6 months after they had been preserved, and each cadaver was used several times. The types of flaps made included the following: oblique triangular flap, reverse digital artery island flap (Fig. 1), latissimus dorsi musculocutaneous flap, superficial temporal fascia flap, nasolabial flap, and anterolateral thigh flap (Fig. 2).Fig. 1: Reverse digital artery island flap.Fig. 2: Anterolateral thigh flap.Because SSS-embalmed cadavers tend to have realistic skin and soft tissue, anatomical structures were easy to identify and the operations could be performed very much as in live patients (Figs. 1, 2). These features of SSS-embalmed cadavers were almost identical to those in Thiel-embalmed cadavers. In addition, the vessels of the SSS-embalmed cadavers were more expanded because of ample fluid, making our detection and isolation of vessels and raising of flaps easier in them than in the Thiel-embalmed cadaver. CONCLUSIONS SSS-embalmed cadavers are sufficiently useful in flap training. The SSS method is simple with a low infection risk and relatively low cost.5 Furthermore, SSS-embalmed cadavers have availability for multiple uses and their vessels can be easily detected. Our trial suggests that the characteristics of SSS-embalmed cadaver may be ideal for trainees of plastic surgery. ACKNOWLEDGMENTS We thank Dr. Ning Qu, Dr. Naoyuki Hatayama, and Dr. Shuichi Hirai for reviewing and providing useful comments to us preparing in our manuscript. We also thank Mr. Shinichi Kawata and Mr. Koichi Koyama for their excellent technical assistance, and Ms. Yuki Ogawa, Ms. Miyuki Kuramasu, and Ms. Keiko Kuwana for their excellent secretarial assistance. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. This study was supported by JSPS KAKENHI Grant Number 26463257. The Article Processing Charge was paid for by the authors. Takayuki Shirai, MD Department of Plastic Surgery Asama General Hospital Saku-shi, Nagano, Japan Department of Anatomy Tokyo Medical University Shinjuku-ku, Tokyo, Japan Shogo Hayashi, MD, PhD Masahiro Itoh, MD, PhD Department of Anatomy Tokyo Medical University Shinjuku-ku, Tokyo, Japan

Innervated Reverse Digital Artery Island Flap through Bilateral Neurorrhaphy using Direct Small Branches of the Proper Digital Nerve.

The reverse digital artery flap uses the radial or ulnar surface of the proximal phalanx of the involved digit and has been applied to sensate flaps using the superficial sensory nerve branch and the dorsal branch of the proper digital nerve. As these nerve branches innervate the dorsal surface of the finger, however, hypesthesia of the dorsal side of the middle phalanx is inevitable. Thirty fingers of 25 patients who had the innervated reverse digital artery flap using direct small branches of the proper digital nerve were included in this study. The minimum follow-up duration was 24 months, and the average defect size was 2.8 cm(2). In all cases, the pulp defects were successfully reconstructed with this flap. The average size of the donor flap was 3.9 cm(2). At 6 months after surgery, the average static two-point discrimination value was 5.9 mm, the average moving two-point discrimination value was 5.0 mm, and the average Semmes-Weinstein monofilament score was 3.79. At 1 year postoperatively, the average Cold Intolerance Severity Score was 20. The percentage total active motion was measured at 99 percent 2 years after surgery. Because this flap does not sacrifice the proper digital nerve or dorsal branch of the nerve, the sensibility of the dorsal aspect of the proximal and middle phalanx can be preserved. This flap is cosmetically excellent, as it uses a donor flap similar to the injured fingertip and the donor scar can be hidden by adjacent fingers. Therapeutic, IV.

Postoperative voluminal flap reduction after fingertip reconstruction using the reverse digital artery island flap.

A total of 16 fingers of 16 patients were subjected to fingertip reconstruction using the reverse digital artery island flap (RDAIF). We evaluated the influences of postoperative flap congestion, initial harvested flap size, patient's age and smoking habit on postoperative final flap size and postoperative range of total active motion (TAM) in affected fingers at a mean interval of 11.4 months. In the results, final flap size and TAM showed a tendency to decrease with increase in the initial harvested flap size and age. Eventually, the final flap size moved towards the size of the fingertip defect. Factors of flap congestion and smoking habit had little influence on the change in flap size and TAM. In conclusion, wide harvested flaps showed significant postoperative reduction in size compared with the small flaps, and extensive skin defect after flap harvest caused a decrease in postoperative TAM. Thus, the size of the harvested RDAIF should be comparable to that of the fingertip defect to prevent postoperative decrease in range of motion in affected fingers, and indication of this flap to the elderly needs to be considered.

Homodigital artery flap reconstruction for fingertip amputation: a comparative study of the oblique triangular neurovascular advancement flap and the reverse digital artery island flap

This fingertip reconstruction study retrospectively compared sensory recovery and active range of motion outcomes in neurovascular island advancement and reverse digital artery island flaps. Seventeen oblique triangular flaps and 14 reverse digital artery island flaps were performed for nail bed level fingertip amputations (Ishikawa subzone II). There was no significant difference between the two procedures in the Semmes-Weinstein monofilament test and range of motion results. For static and moving two-point discrimination tests, however, those with a reverse digital artery island flap required a longer period for sensory recovery compared to those with an oblique triangular advancement flap. This trend equilibrated at 12 months after surgery showing no significant difference in both static and moving two-point discrimination tests between the procedures.

Clinical application of dorsal proximal phalangeal flap for covering donor site defect of reverse digital

Objective To introduce the surgical techniques of repairing donor site defect of reverse digital artery island flap by perforator flap from the dorsum of the proximal phaalanx. Methods Fifteen cases with skin defects of the fingertips were treated with reverse digital artery island flap transfer.Defects at the donor site were repaired with perforator flap from the dorsum of the proximal phalanx. Results All 30 flaps survived in 15 cases.The patients were follow-up for 5 months to 2 years.The appearance and the texture of the flaps were good.The fingers were pain free.Two-point discrimination was 7 to 8 mm for the island flaps and 8 to 10 mm for the perforator flaps.According to the hand function evaluation criteria issued by the Chinese Hand Society,the hand function was graded as excellent in 13 cases and good in 2 cases.There were no obvious complications of the donor sites.The width and depth of the web space were not affected.There was no web contracture and finger abduction reached 30° to 40°, close to normal. Conclusion This procedure is easy and effective.The treatment result is satisfactory.It is an improvement over conventional donor site defect repairing techniques in reverse digital artery island flap transfer. Key words: Finger injuries; Surgical flaps; Tissue defect

Comparison of repair distal soft tissue defect with two kind of reverse digital artery island flaps

Objective To analysis the clinic outcome (similarities & differences, indication and caution) of repairing fingertip soft tissue defect with two kind of reverse digital artery island flaps with the palmar cutaneous branch of proper digital nerve. Methods From January 2000 to Auguest 2008, all 500cases (514 fingers) were repaired with reverse homodigital artery island flap (263 fingers of 250 cases) and reverse cross finger digital artery island flap(251 fingers of 250 cases).All cases were followed up from 3-8years,compared with flap range,finger extension,sensory rehabilitation,et al. Results All flaps (A & Bgroup) of 500 cases (514 fingers) survived.According to flap range,cross finger flap was better than homodigital flap (P ＜ 0.05); according to finger extension,homodigital flap better than cross finger flap (P ＜0.05); according to sensory rehabilitation,homodigital flap little better than cross finger flap(P ＜ 0.05); according to long-term follow-up, all had no obviously different (P ＞ 0.05). Conclusion Homodigital flap can cover distal soft tissue defect less than 2.0 cm× 2.5 cm, cross finger flap is a better choice for more than 2.0cm×3.0cm of distal soft tissue defect. According to the flap cover area, cross finger flap is first choice,and to finger extension & sensory rehabilitation,homodigital flap is first choice; accoding to finger movements,two kinds of flaps are all good choice. Key words: Homodigital flap; Cross finger flap; Island flaps; Finger; Microsurgery