Simultaneous proximal interphalangeal joint arthroplasty and extensor tendon reconstruction in adjacent fingers: case report

Clinical application of dorsal digital cutaneous branch flap with partial extensor tendon in repairing compound tissue defects of the dorsal finger

Purpose: To investigate the clinical efficacy of using dorsal digital cutaneous branch flap with partial extensor tendon in repairing compound tissue defects of the dorsal digits of the hand. Methods: Between January 2018 and January 2020, ten patients with skin and soft tissue defects of the digits accompanied by extensor tendon defects underwent surgical repair using dorsal digital cutaneous branch flap with partial extensor tendon. The donor site was repaired with dorsal metacarpal artery flap. The smallest skin defect area was 2.0 × 1.5 cm, while the largest skin defect area was 4.0 × 3.0 cm. The length of tendon defect ranged from 1.5 to 3.0 cm. Sensation within the flap, aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work time were measured. Results: All 10 flaps survived after surgery. All patients were followed up for 12-18 months, with an average follow-up period of 15.4 months. After flap repair, the digits had satisfactory shape and appearance along with a soft texture. Hand function was excellent in eight cases and good in two cases. Two-point discrimination was 6-9 mm with an average of 8 mm. No patient experience cold intolerance. The donor sites healed well with satisfactory appearance. Conclusion: Dorsal digital cutaneous branch flap with partial extensor tendon could be used to repair skin and tendon defects simultaneously. The advantages of this method include simple donor tissue harvesting; less donor-site morbidity; reliable blood supply; and satisfactory recovery of appearance, sensation, and function of the flap. Therefore, this method could be suitable for repairing soft tissue defects of the dorsal digits with extensor tendon defects.

Complications, reoperations and revisions after proximal interphalangeal joint arthroplasty: a systematic review and meta-analysis

This systematic review and meta-analysis investigates the prevalence of complications, reoperations (surgeries without implant modifications) and revisions (surgeries with implant modifications) after proximal interphalangeal joint arthroplasty with pyrocarbon, metal-polyethylene and silicone implants. Thirty-four articles investigating 1868 proximal interphalangeal joints were included. Implant-related complications were associated with 14%, 10% and 11% of the pyrocarbon, metal-polyethylene and silicone implants, respectively, yet these rates were not significantly different from one another. Silicone implants showed more finger deviations (3%) and instabilities (2%) compared with the other implants. Reoperations were fewer for silicone arthroplasties (1%) compared with pyrocarbon (7%) and metal-polyethylene implants (10%). The revision rates of 4%, 3% and 2% were similar for pyrocarbon, metal-polyethylene and silicone implants. Our results indicate that silicone implants remain a valuable option for the treatment of stable proximal interphalangeal joints. Surface replacing implants might be better to correct unstable or deviated proximal interphalangeal joints, although they are associated with a higher risk of reoperations.