‘Mini’ free groin flap for treatment of a tufted angioma of the finger

Tufted Angioma of the Index Finger Middle Phalanx

A tufted angioma is a benign vascular tumor of the skin and subcutaneous tissue that classically presents as a violaceous nodule on the trunk or extremities in early childhood. Tufted angiomas of the finger are uncommon, and intraosseous involvement of these tumors is exceedingly rare. When present in the bone, these lesions may be difficult to distinguish from the more common pediatric condition of osteomyelitis or osteoid osteoma. We present the clinical, radiographic, and histopathologic findings for a unique case of a tufted angioma with intraosseous involvement in the middle phalanx treated by surgical excision and curettage with preservation of function.

Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap

BACKGROUND

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.

METHODS

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 ± 0.4 cm in length and 1.8 ± 0.4 cm in width. The defects were reconstructed with a modified cross-finger flap.

RESULTS

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.

CONCLUSIONS

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.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Contralateral abdominal pocketing in salvation of replanted fingertips with compromised circulation

Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.

Congenital and infantile skin lesions affecting the hand and upper extremity, part 1: vascular neoplasms and malformations

Many dermatologic conditions may be present on a newborn infant's upper extremity that can evoke concern for parents and/or primary caregivers. Although the pediatrician typically remains the first care provider, often these children are referred to specialists to diagnose and treat these lesions. Hand surgeons should be familiar with different infantile skin lesions on an upper extremity. Some lesions are best observed, whereas others require treatment with nonoperative measures, lasers, or surgical interventions. A 2-part series is presented to aid the hand surgeon in becoming familiar with these lesions. This part 1 article focuses on vascular neoplasms and malformations. Particular attention is paid to the multiple types of hemangiomas and hemangioendotheliomas, telangiectasias, angiokeratomas, as well as capillary, venous, and lymphatic malformations. Diagnostic tips and clinical photographs are provided to help differentiate among these lesions. In addition, the recommended treatment for each is discussed.