Repair of dorsal defects over the middle phalanx and proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

Retrograde versus anterograde palm venous anastomosis in avulsion distal fingertip trauma: Functional and therapeutic outcomes (FTO) analysis

BACKGROUND/OBJECTIVES

The advance in the microvascular surgeries has made successful replantation of amputee fingertip or toe. Anterograde palm venous anastomosis is generally preferred in avulsion distal fingertip trauma surgeries but is technically challenging. The retrograde venous anastomosis is proved to be easy and effective in larger defects hand reconstruction surgeries. The purposes of the analysis were to compare functional and therapeutic outcomes of retrograde palm venous anastomosis against anterograde palm venous anastomosis in the avulsion distal fingertip and thumb microvascular surgery.

METHODS

Digits were replanted by retrograde palm venous anastomosis (n = 130, RPVA cohort) or anterograde palm venous anastomosis (n = 220, APVA cohort). The data regarding the survival of transplanted tissues, analgesia, 2-points discrimination, and total active movement after 2-years of surgeries were collected and analyzed.

RESULTS

A higher percentage of digits with survived transplanted tissues found in the RPVA cohort than the APVA cohort (p = 0.004). 2-points discrimination found higher in the APVA cohort than the RPVA cohort (5.22 ± 1.56 mm vs. 4.81 ± 1.39 mm, p = 0.014). The pain was fewer in the RPVA cohort than the APVA cohort (p = 0.041). A total active motion was higher in the RPVA cohort than the APVA cohort (p = 0.025). Anterograde palm venous anastomosis (p = 0.021) were associated with the failure of transplanted digits tissues.

CONCLUSIONS

Retrograde palm venous anastomosis had better functional and therapeutic outcomes than anterograde palm venous anastomosis in avulsion distal fingertip trauma.

LEVEL OF EVIDENCE

III.

Palmar island flaps used to cover dorsolateral finger defects

Soft-tissue injuries of the hand are devastating injuries that may need coverage. Dorsal and/or lateral defects of the fingers with exposed tendon and/or bone are challenging obstacles in reconstructive hand surgery. There are several options for coverage of dorsal defects of the fingers, but all have shortcomings. A reliable 1-stage local flap to coverage the dorsolateral finger defects is needed. Anatomic study of Omokawa and their colleagues showed that palmar area is supplied by several perforators from the superficial palmar arch, and the common and proper digital arteries. The distal portion of the palm has numerous (range, 8 to 15) and large diameter (range, 0.1 to 0.5) perforators with good vascularity. Therefore, on the basis of this anatomic consideration, palmar island flap can be elevated. This flap is a simple, reliable, effective, and versatile flap which could be borne in mind as the best option to the hand surgeons treating soft-tissue defects of the hand.

Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

This article describes the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of the volar defects at the proximal interphalangeal joint. The flap was based on the first dorsal branch of the proper digital artery. From January 2007 to March 2009, 14 digits in 14 patients (10 males and 4 females) were treated. There were 5 index, 6 middle, 2 ring, and 1 little finger. All patients underwent surgery 2-9 hours (mean 5 hours) after injury. Soft tissue defects ranged in size from 1.2 × 1.7 cm to 2.1 × 2.3 cm (mean 1.7 × 2 cm). Flap size ranged from 1.5 × 1.7 cm to 2.4 × 2.7 cm (mean 2 × 2.4 cm). Mean pedicle length was 1.1 cm (range 0.8-1.4 cm). All flaps completely survived. At final follow-up from 24-29 months (mean 26 months), mean active motion arcs of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 84° (range 75-91°), 86° (range 65-100°) and 54° (range 32-80°), respectively. Our technique is useful and reliable for coverage of a palmar defect over the proximal interphalangeal joint.