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Kuwahara Y, Hara T, Kurahashi T, Kitami T, Tatebe M. Comparing clinical and aesthetic outcomes of cross-finger and homodigital reverse digital artery island flap for fingertip injuries: A single-center retrospective cohort study. J Plast Reconstr Aesthet Surg 2024; 95:411-418. [PMID: 38734540 DOI: 10.1016/j.bjps.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Reverse homodigital artery island flap (RHDI) has been reported to have some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been used to decrease these complications. This study aimed to provide a review of the CRDI procedure and compare the clinical outcomes of CRDI with those of RHDI. METHODS RHDI has been performed for fingertip amputations with deficit of 1.5-2.5 cm before 2018, and CRDI has been performed since 2018. We assessed the functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up. RESULTS We identified 22 patients who underwent RHDI and 10 patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing were 47.0 days (IQR: 34.3-55.8 days) and 34.5 days (IQR: 29.3-44.3 days) in RHDI and CRDI, respectively. The hook nail deformity occurred significantly more frequently in RHDI compared to that in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found to be 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: 260-280º). The median postoperative Hand20 scores were similar between the two groups. CONCLUSION CRDI was associated with superior clinical outcomes in terms of lower rates of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.
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Affiliation(s)
- Yutaro Kuwahara
- Anjo Kosei Hospital, Orthopedic surgery, Anjo, Aichi, Japan.
| | - Tatsuya Hara
- Anjo Kosei Hospital, Orthopedic surgery, Anjo, Aichi, Japan
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Brix E, Prantl L, Anker A, Klein S, Kehrer A. Free neurovascular toe-(joint)-transfers compared to alternative reconstructive procedures for amputation injuries of two and tripartite fingers with substance loss. Clin Hemorheol Microcirc 2024; 86:71-88. [PMID: 37742630 DOI: 10.3233/ch-238114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Complex injuries of the hand frequently result in loss of essential functional features. Common reconstructive procedures for soft tissue defects of the thumb or phalanges are locoregional flaps like Moberg-, Foucher-, Cross-Finger- or Littler flaps. Microneurovascular toe (joint-) transfers complete the arsenal of operative reconstructive procedures and allow for most detailed reconstructions. Our experiences with free toe transplants are reported and diversely discussed regarding contending procedures. METHODS From 2010 until 2019 14 patients who received emergency or elective partial or complete toe transfers were compared with a control group (n = 12) treated with contending reconstructive procedures. Aim of the reconstructions was to cover the defect with well-vascularized, sensate tissue, while preserving length and range of motion in a reliable manner. RESULTS The Kapandji score showed a significant difference (p- value = 0.04) with a score of 9.8 in comparison to control group (Kapandji index = 8.0). CONCLUSION In our heterogenic patient collective free toe transplants have proven to achieve comparable functional results for reconstruction of two and tripartite phalanxes as opposed to common local reconstructive procedures.
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Affiliation(s)
- E Brix
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - L Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A Anker
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - S Klein
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A Kehrer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
- Department of Plastic and Reconstructive Surgery, Ingolstadt Hospital, Ingolstadt, Germany
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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 2023:S0949-2658(23)00251-8. [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] [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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Üstün GG, Öztürk S, Koçer U. Standardization of the Rat Dorsal Random Pattern (McFarlane) Flap Model and Evaluation of the Pharmacological Agents Aiming to Salvage Partial Flap Necrosis: A Systematic Review and a Meta-analysis. Ann Plast Surg 2021; 87:e145-e152. [PMID: 34818287 DOI: 10.1097/sap.0000000000002919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Partial flap necrosis is a common complication after surgery. McFarlane flap model has been used for assessment of various agents' effects on random flap survival. The aim of this study was to review the methodology of studies using this flap model and reveal the most successful agents. MATERIALS AND METHODS PubMed, Scopus, and Web of Science databases were screened for words "McFarlane flap," "flap survival," and ("flap" and "rat") by using time limits between 1965 and 2019. A total of 71 original articles were reviewed. Dimensions and base (cranial/caudal) of the flap, treatment protocol, follow-up period, and survival rates were extracted. Modified survival rates were calculated. Coefficients of variation of cranial/caudally based control group flaps and most commonly used flap models were calculated to assess interstudy variability. RESULTS A total of 165 different treatment regimens were studied. One-hundred twelve regimens (67.9%) were found to increase flap survival. Most common flap dimensions were 9 cm × 3 cm, followed by 10 cm × 3 cm, 8 cm × 2 cm and 6 cm × 2 cm. Studies using caudally based flaps showed less interstudy variability, but survival rates were similar. Pentoxifylline, sildenafil, chlorpromazine, phenoxybenzamine, and phentolamine were reported to be successful in multiple studies. CONCLUSIONS There are numerous agents found to be effective for treatment of partial flap necrosis, but further clinical research is needed. To overcome standardization problems, use of commonly used flap dimensions with a caudal base and interpretation of results after 7 days of follow-up seems appropriate.
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Affiliation(s)
- Galip Gencay Üstün
- From the Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey
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Pertea M, Ciobanu P, Velenciuc N, Poroch V, Filip A, Moraru DC, Lunca S, Veliceasa B. Utility of "reposition-flap" in the reconstruction of the avulsed thumb. Medicine (Baltimore) 2021; 100:e27290. [PMID: 34559139 PMCID: PMC8462580 DOI: 10.1097/md.0000000000027290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/02/2021] [Indexed: 01/05/2023] Open
Abstract
Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to "sacrifice" another anatomical region for thumb reconstruction, the "reposition-flap" technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using "reposition-flap" with an O'Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.
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Affiliation(s)
- Mihaela Pertea
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Petru Ciobanu
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Natalia Velenciuc
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- 2nd Surgical Clinic, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Vladimir Poroch
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Palliative Care Department, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Alexandru Filip
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Orthopaedics and Traumatology Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţeinr. 1, Iaşi, Romania
| | - Dan Cristian Moraru
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Plastic Surgery and Reconstructive Microsurgery Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţei nr. 1, Iaşi, Romania
| | - Sorinel Lunca
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- 2nd Surgical Clinic, Regional Institute of Oncology, Strada G-ral Berthelot 2-4, Iasi, Romania
| | - Bogdan Veliceasa
- University of Medicine and Pharmacy “Grigore T. Popa”, Strada Universitxăţii 16, Iaşi, Romania
- Orthopaedics and Traumatology Clinic, Emergency Hospital “Sf. Spiridon”, Bulevardul Independenţeinr. 1, Iaşi, Romania
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Masaki S, Kawamoto T. Fingertip Amputation Injury of Allen Type III Managed Conservatively with Moist Wound Dressings. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928950. [PMID: 33621217 PMCID: PMC7913779 DOI: 10.12659/ajcr.928950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/15/2021] [Accepted: 01/05/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fingertip amputation injury is treated surgically or conservatively. Management strategies for these injuries vary depending on not only the site and the degree of tissue loss in the wound but also the country and region. Conservative management or revision amputation is common in the United States. On the other hand, operative management such as replantation or reconstruction is preferred in Japan; accordingly, a surgery is performed even in cases eligible for conservative management. Here, we report a case of fingertip amputation injury for which reconstructive surgery was recommended by a plastic surgeon, but the patient opted for conservative treatment, which was performed using moist wound dressings. CASE REPORT A 36-year-old woman suffered an Allen type III fingertip amputation injury with her right middle finger crushed in a thick iron door. The amputated fingertip was not retrieved. The plastic surgeon in charge initially recommended reconstructive surgery to the patient. However, the patient opted for conservative management; therefore, she visited the Wound Care Department in our hospital. Conservative treatment using moist wound dressings (Plus moist™) was performed, and the wound healed after 12 weeks, with outstanding aesthetic and functional results. CONCLUSIONS Conservative management with moist wound dressings can be a successful treatment modality for Allen type III fingertip amputation injury. In cases where the fingertip amputation injury can be treated using either surgery or conservative treatment, it is better to prioritize the patient's wishes when selecting the treatment option.
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Affiliation(s)
- Shigenori Masaki
- Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Takashi Kawamoto
- Department of Neurosurgery, Miyanomori Memorial Hospital, Sapporo, Hokkaido, Japan
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V-Y advancement flaps belong in the orthopaedic resident’s emergency department armamentarium: a case report of two patients. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Retrograde flow digital artery flaps are a versatile single-stage option for the coverage of fingertip and dorsal digit defects. There are technical challenges associated with pedicle dissection and preparation. Techniques vary predominantly in the vessel utilized (either the proper digital artery or its branches) and the incorporation of the digital nerve or its branches in the pedicle with subsequent neurorrhaphy. Venous failure is more common. There is often mild but perceivable donor site morbidity. Evidence favors an innervated flap for better sensory recovery. Cold intolerance follows sacrifice of a digital artery.
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Affiliation(s)
- Benjamin Zhi Qiang Seah
- Department of Hand & Reconstructive Microsurgery, National University Health System, Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228
| | - Sandeep J Sebastin
- Department of Hand & Reconstructive Microsurgery, National University Health System, Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228.
| | - Alphonsus Khin Sze Chong
- Department of Hand & Reconstructive Microsurgery, National University Health System, Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228
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Oh J, Eun SC. Bilateral Free 2nd Toe Pulp Flap for Reconstruction of Soft Tissue Defect in Traumatic Finger Injuries. JOURNAL OF TRAUMA AND INJURY 2019. [DOI: 10.20408/jti.2019.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jeongseok Oh
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seok Chan Eun
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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