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Uzel K, Çelik V, Abacı YH, Eskandari MM. Outcomes of antegrade homodigital neurovascular island flap in fingertip amputations. J Orthop Sci 2024; 29:1203-1207. [PMID: 37839979 DOI: 10.1016/j.jos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/26/2023] [Accepted: 08/09/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Antegrade homodigital neurovascular island flap (AHIF) is one of the methods used in fingertip amputations to cover the defect area, preserve finger length and obtain a painless and sensitive fingertip. The aim of this study was to evaluate the functional and sensory outcomes in patients who underwent AHIF for fingertip amputation and to analyze the relationship between patient satisfaction and outcome measures. METHODS Twenty patients with a mean age of 37 (18-63) years were analyzed retrospectively. The patients were evaluated in terms of hook nail development, active interphalangeal joint movements, cold intolerance, and sensory function of the flap covered area. Static two-point discrimination test and Semmes Weinstein monofilament test were performed for sensory evaluation. RESULTS All flaps survived completely at the end of follow-up (mean, 36 months; range 11-64 months). Five patients had cold intolerance and two had hook nails. In total, proximal interphalangeal or distal interphalangeal joint flexion contracture developed in 25 % of the patients. The mean static two-point discrimination score was 4.6 ± 1.6 (2-8) and Semmes-Weinstein monofilament test score was 3.48 ± 0.6 (2.44-4.17). Subjective satisfaction levels of the patients were found to be high and did not show a statistical relationship with the measured clinical outcome parameters (p > 0.05). CONCLUSIONS Since AHIF contains a solid and continuous neurovascular pedicle, the probability of necrosis and loss of sensation is low in AHIF. In addition, the graft need of the donor area is not high. Its disadvantage is the rate of restriction of joint movements. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kadir Uzel
- University of Medipol, School of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
| | | | | | - Metin Manouchehr Eskandari
- University of Mersin, School of Medicine, Department of Orthopaedics and Traumatology, Division of Hand Surgery, Mersin, Turkey.
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Khan WU, Appukuttan A, Loh CYY. Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options. JPRAS Open 2022; 34:199-218. [DOI: 10.1016/j.jpra.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
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Onode E, Takamatsu K, Kazuki K, Nakamura H. Bipedicled Digital Artery Perforator Volar Adiposal Turned-Over Flap for Reconstruction of Transverse Fingertip Amputation. JPRAS Open 2022; 32:111-115. [PMID: 35345615 PMCID: PMC8956959 DOI: 10.1016/j.jpra.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ema Onode
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
- Corresponding author.
| | - Kiyohito Takamatsu
- Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Kenichi Kazuki
- Department of Orthopaedic Surgery, Gakuen Minami Clinic, Nara, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Ayhan E, Çevik K, Çelik V, Eskandari MM. Patient satisfaction after innervated digital artery perforator flap for fingertip injuries. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:269-275. [PMID: 32544063 DOI: 10.5152/j.aott.2020.03.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the results of the innervated digital artery perforator (IDAP) flap and to analyze the relationship between patient satisfaction and outcome measures. METHODS A total of 17 fingertips of 15 patients (14 men and one woman; mean age: 47.2 (26-62) years) were included in this retrospective study. Patients' injured finger and defect type were recorded. At the last follow-up, the static two-point discrimination (s2PD) test, Semmes Weinstein monofilament (SWM) test, and range of motion of the affected finger were analyzed. We interviewed patients to determine hand dominance, cold intolerance, and their satisfaction with the result. We performed correlation and logistic regression analyses between patient satisfaction and outcome measures. RESULTS The mean follow-up period was 13.8 (7-18) months. The mean range of motion was 77.3±3.5 (70-80) degrees for the distal interphalangeal joints of affected fingers. The mean s2PD was 6.4 (3-10) mm, and the SWM records ranged from 2.83 to 4.93 monofilament markings. Cold intolerance was noted in seven fingers (41%). Patient satisfaction was negatively correlated with cold intolerance, and cold intolerance decreased as the follow-up period extended. CONCLUSION IDAP flap satisfies both patient and surgeon, with the only significant problem being cold intolerance, regarding which patients must be informed. Although cold intolerance is hard to treat, fortunately, it generally improves with time. LEVEL OF EVIDENCE Level IV, Therapeutic study.
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Affiliation(s)
- Egemen Ayhan
- Division of Hand Surgery, Department of Orthopaedics and Traumatology, University of Health Sciences Turkey, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Kadir Çevik
- Department of Orthopaedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey
| | - Velat Çelik
- Clinic of Hand Surgery, İskenderun State Hospital, Hatay, Turkey
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Karjalainen T, Jokihaara J. A Review and Meta-analysis of Adverse Events Related to Local Flap Reconstruction for Digital Soft Tissue Defects. Hand Clin 2020; 36:107-121. [PMID: 31757343 DOI: 10.1016/j.hcl.2019.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We reviewed the current literature to estimate incidence rates for adverse events with pedicled flaps in the hand. We identified 241 different studies reporting adverse events for 6693 flaps. The average incidence rate was 5.4% and total or partial loss of flap constituted 65% of all reported complications. Flaps with reverse or perforator-based flow may be more prone to vascular complications compared with flaps with antegrade flow or skin pedicle. The incidence rates were acceptable in all flaps (1%-10%) and thus the flap can be chosen primarily based on considerations other than risk of adverse events.
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Affiliation(s)
- Teemu Karjalainen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash Department of Clinical Epidemiology, Cabrini Hospital, Monash University, Malvern, Australia; Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 16, Jyväskylä 40620, Finland.
| | - Jarkko Jokihaara
- Department of Hand Surgery, Tampere University Hospital, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland; Faculty of Medicine and Health Technology, Tampere University, TAYS/TUL2, Teiskontie 35, Tampere 33521, Finland
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Abstract
This review article summarizes the various types of digital artery perforator flaps used in digit reconstruction. The indications for use of digital artery perforator flaps and the preferred approach for reconstructing fingertip defects are explained in this article. Recent updates in digital artery perforator anatomy in the finger, techniques for flap harvest, and inset as well as a delayed approach to using digital perforator flaps in finger reconstruction are discussed.
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Abstract
The authors' strategy for soft-tissue coverage of the hand is presented. The concept of replacing like with like and reconstruction with similar adjacent tissue enhances functional and aesthetic outcomes. In this viewpoint, the pedicle perforator flap is an ideal flap. A decision-making algorithm to select an ideal flap for a particular hand defect is challenging, requiring experiential consideration of functional outcome, appearance, donor-site morbidity, and patient satisfaction. To assist surgeons in determining the most appropriate flap with more evidence, studies are necessary to compare the outcomes of each flap by evaluating hand function, aesthetics, donor site morbidity, and patient satisfaction.
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Zhu ZW, Zou XY, Huang YJ, Liu JH, Huang XJ, He B, Wang ZT. Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children. Neural Regen Res 2017; 12:1911-1917. [PMID: 29239339 PMCID: PMC5745847 DOI: 10.4103/1673-5374.219053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.
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Affiliation(s)
- Zhao-Wei Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province; Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiao-Yan Zou
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yong-Jun Huang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
| | - Jiang-Hui Liu
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xi-Jun Huang
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Bo He
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zeng-Tao Wang
- Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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Epameinondas K, Christos A, Petros K, Avraam D, Othon P, Vincent C. Predictable Pattern Digital Artery Perforator Flap: An Alternative Concept in Digital Reconstruction. Hand (N Y) 2016; 11:88-96. [PMID: 27418896 PMCID: PMC4920505 DOI: 10.1177/1558944715614839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The proper digital arteries as any other axial vessel give rise to multiple cutaneous perforators either volar or dorsal along their course. Their identification is performed with Doppler flowmetry. The vasculo-cutano-tendino-osseous complex (VCTOC), which was described by the senior authors, was responsible for the vascularization of all digital anatomic structures (extensor apparatus, skin, periosteum). Their consistent appearance to well measured distances from the digital joints led the way to the present clinical study for highlighting this described anatomy in-vivo and demonstrating the predictability in digital artery perforator (DAP) flap harvest. METHODS From November 2012 to March 2014, fifteen patients underwent reconstruction with a predictable pattern digital artery perforator flap (PPDAP), based on the previously described VCTOC mapping, for digital lesions secondary to tumor extirpation. Flaps were designed as V-Y advancement or propeller type. Postoperative control concerned flap viability and digital function. RESULTS Seven males and 8 females underwent elective surgery using PPDAP flaps for digital defects following tumor extirpation. The diameter of the defect ranged from 0.5 to 1.5 cm. The vast majority of the lesions were identified on the right hand, the index, the ring finger and the distal phalanx. All flaps survived without signs of venous congestion. No functional digital problems were observed during follow up (mean of 77 months). A minor wound dehiscence presented in one patient. CONCLUSIONS Authors introduced the concept of a "predictable pattern" in the surgery of perforator flaps in the digits. These flaps are reliable and could be a valuable reconstructive option.
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Affiliation(s)
- Kostopoulos Epameinondas
- Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece,Kostopoulos Epameinondas, Plastic Surgeon, Hand Surgeon, University Department of Plastic Surgery, Athens University Medical School, Syggros Dermatological Hospital, 120 D. Gounari Street, 15125 Maroussi-Athens, Greece.
| | - Agiannidis Christos
- Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece
| | - Konofaos Petros
- Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece
| | - Dounavis Avraam
- Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece
| | - Papadopoulos Othon
- Athens University Medical School, Syggros Dermatological Hospital, Athens, Greece
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Innervated Digital Artery Perforator Flap: A Versatile Technique for Fingertip Reconstruction. J Hand Surg Am 2015; 40:2352-7. [PMID: 26527595 DOI: 10.1016/j.jhsa.2015.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To demonstrate the advanced use of innervated digital artery perforator (IDAP) flaps for fingertip reconstruction. METHODS From August 2011 to May 2014, 65 fingers (59 patients) underwent fingertip or finger stump reconstruction using IDAP flaps. Sixty-one fingers from 55 patients who were followed up for more than 6 months were included in this study. The objective outcomes of patient evaluations consisted of the results of static 2-point discrimination tests, Semmes Weinstein monofilament tests, and extension loss tests. The subjective patient outcome evaluations consisted of the results of hypersensitivity and cold intolerance tests and patient satisfaction. RESULTS All flaps survived completely, and no patients required early secondary interventions. The mean follow-up period was 18 months (range, 6-36 months). The static 2-point discrimination in the flaps ranged from 2 to 6 mm (mean, 3.5 mm) compared with a range of 2 to 3 mm (mean, 2.5 mm) in the contralateral hands. The Semmes Weinstein monofilament test results ranged from 0.07 to 1.4 g compared with 0.04 to 0.4 g for the contralateral hand. One patient exhibited mild extension loss in the reconstructed finger, 4 patients experienced mild cold intolerance, and 2 patients exhibited mild hypersensitivity. CONCLUSIONS The IDAP flaps are sensitive, reliable, and versatile and should be considered for reconstructing acute fingertip defects. The use of IDAP flaps for revisions of previously reconstructed defects is also possible. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Wong VW, Katz RD, Higgins JP. Interpretation of upper extremity arteriography: vascular anatomy and pathology [corrected]. Hand Clin 2015; 31:121-34. [PMID: 25455362 DOI: 10.1016/j.hcl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding the utility and interpretation of upper extremity angiography is critical for the hand surgeon treating vaso-occlusive diseases of the hand. Although invasive and requiring the use of contrast dye, it remains the gold standard for imaging of the vascular system of the upper extremity. Angiography may detect numerous variants of the upper limb arterial system which may contribute to surgical pathology. Extensive vascular collateralization helps to maintain perfusion to the hand and facilitates reconstruction of the upper extremity. It is paramount to remember that angiography is a dynamic study and should represent a "flexible roadmap" for surgical reconstruction.
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Affiliation(s)
- Victor W Wong
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street #200, Baltimore, MD 21218, USA.
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Zhu L, Xu Q, Kou W, Ning B, Jia T. Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects. Indian J Orthop 2014; 48:594-8. [PMID: 25404772 PMCID: PMC4232829 DOI: 10.4103/0019-5413.144228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Lei Zhu
- Department of Hand and Foot Surgery, Qilu Hospital, Shandong University, Jinan, China,Department of Orthopaedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Qingjia Xu
- Department of Hand and Foot Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Wei Kou
- Department of Orthopaedic Surgery, Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China
| | - Bin Ning
- Department of Orthopaedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Tanghong Jia
- Department of Orthopaedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, China,Address for correspondence: Dr. Tanghong Jia, Department of Orthopaedic Surgery, Jinan Central Hospital Affiliated to Shandong University, No. 105, Jiefang Road, Jinan 250013, Shandong, P. R. China. E-mail:
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