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Chu T, Xiao J, Tao Z, Zheng Z, Wang A, Lin D, Li Z, Chen X, Gao W. A hitchhiking approach to reconstruct the finger pulp and the subsequent 1st toe hemi-pulp donor site defect. J Plast Reconstr Aesthet Surg 2021; 75:651-658. [PMID: 34740566 DOI: 10.1016/j.bjps.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The free 1st toe hemi-pulp transfer for finger pulp reconstruction was acknowledged as the optimal one. However, the treatment of the 1st toe donor defect, owning to the impossibility of primary closure, was frequently oversimplified. This study presented a "hitchhiking" approach to resurface finger pulp and the subsequent 1st toe donor site defect in a one-stage procedure. METHODS From 2014 to 2019, finger pulp amputations (13 digits in 12 patients) were reconstructed with free 1st toe pulp flaps, and the donor site was resurfaced by the 2nd toe pedicled flap with the 2nd toe's primary closure. Therapeutic evaluation of repaired fingers and toes was based on cold intolerance, two-point discrimination (2PD), and gait disturbance. RESULTS All finger and toe pulp flaps survived uneventfully. The average size of free 1st toe and pedicled 2nd toe flap was 3.1 cm × 2.0 cm (3.5 cm × 1.4 cm to 4.2 cm × 2.5 cm) and 3.0 cm × 1.1 cm (2.0 cm × 0.9 cm to 3.8 cm × 1.5 cm), respectively. The regained average static 2PD on the finger and 1st toe pulps was 6 mm (ranged 5-10 mm) and 4 mm (ranged 2-6 mm), respectively. All reconstructed 1st toe pulps were qualified for normal gait. One patient complained the mild cold intolerance, and hammer-toe deformities were involved in two cases. CONCLUSION To fulfill donor site care and cost-effective rule, the toe-to-finger pulp reconstruction can't underestimate the morbidity on 1st toe donor site due to inappropriate intervention. Equally importantly, the hitchhiking pedicled 2nd toe flap should be recruited in the reconstructive scheme.
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Affiliation(s)
- Tinggang Chu
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Jian Xiao
- Department of Optometry & Ophthalmology, Wenzhou Medical University, Xueyuan West Road 270#, Wenzhou 325027, Zhejiang Province, PR China
| | - Zhengyu Tao
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Zengming Zheng
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Anyuan Wang
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Damu Lin
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Zhijie Li
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Xinlong Chen
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China
| | - Weiyang Gao
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, PR China.
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Optimization of the homodigital antegrade island flap for fingertip reconstruction: New dissection sequence based on cadaver study findings. Orthop Traumatol Surg Res 2020; 106:335-339. [PMID: 32199786 DOI: 10.1016/j.otsr.2020.01.002] [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] [Received: 09/24/2019] [Revised: 12/11/2019] [Accepted: 01/05/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The homodigital antegrade island flap pedicled on the proper palmar digital artery is very useful for covering fingertip defects. However, it has its drawbacks, such as the risk of stiffness due to retractile scars and the need for extensive dissection with long-lasting dysesthesia in some cases. In clinical studies, expanding the skin paddle with V-shaped incisions increases the flap's advancement. We wanted to know whether making these V incisions for paddle expansion would make dissection on the volar side of the proximal interphalangeal joint unnecessary. METHODS A cadaver study was performed with four fresh-frozen upper limbs. Sequential dissection was carried out on 32 flaps, allowing us to compare the advancement obtained and the area of the flap's paddle between each step. RESULTS Crossing the palmar crease of the proximal interphalangeal joint provides only 2mm advancement of the homodigital antegrade flap. Adding one or two V-shaped incisions in the flap with limited dissection provides additional advancement of 4.1mm (p<0.05) and 6.9mm (p<0.05) relative to the standard flap. DISCUSSION Our study shows the possibility of increasing the homodigital antegrade flap's advancement - without having to extend the dissection proximally to the PIP joint - by making V-shaped incisions in the paddle. Based on our findings, we have proposed a new flap dissection sequence.
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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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A Systematic Review of Outcomes after Revision Amputation for Treatment of Traumatic Finger Amputation. Plast Reconstr Surg 2015; 136:99-113. [PMID: 26111316 DOI: 10.1097/prs.0000000000001487] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Revision amputation is often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact is poorly understood. The authors performed a systematic review to evaluate outcomes of revision amputation and amputation wound coverage techniques. METHODS The authors searched all available English literature in the PubMed and Embase databases for articles reporting outcomes of nonreplantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes, and complications. RESULTS A total of 1659 articles were screened, yielding 43 studies for review. Mean static two-point discrimination was 5.0 ± 1.5 mm (n = 23 studies) overall, 6.1 ± 2.4 mm after local flap procedures, and 3.8 ± 0.4 mm after revision amputation. Mean total active motion was 93 ± 8 percent of normal (n = 6 studies) overall. It was 90 ± 9 percent of normal after local flap procedures and 95 percent of normal after revision amputation. Seventy-seven percent of patients reported cold intolerance after revision amputation. Ninety-one percent of patients (217 of 238) reported "satisfactory" or "good/excellent" ratings regardless of treatment. CONCLUSIONS Revision amputation and conservative treatments result in better static two-point discrimination outcomes compared with local flaps. All techniques preserve total active motion, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report "satisfactory," "good," or "excellent" ratings in appearance and quality of life with all nonreplantation techniques.
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Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F. Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg 2015; 41:325-59. [PMID: 24996458 DOI: 10.1016/j.cps.2014.04.004] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this review, an international group of senior hand surgeons was asked to provide their currently used methods, views, and advice on thumb and fingertip repair. The basic requirements and methods of thumb and fingertip repair are first outlined, followed by descriptions of the methods favored by individual units or surgeons. More recent innovative methods and modifications are described and challenging topics are discussed. This review ends by illustrating and discussing a few exploratory treatments that hold promise of greatly changing future perspectives of this common clinical problem.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China.
| | - David Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Verona Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37126, Italy
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Felix Stang
- Plastic Surgery, Hand Surgery, and Burns Unit, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany
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Abstract
Examining the evolution of flap reconstruction of the upper extremity is similar to studying the evolution of biological species. This analogy provides a perspective to appreciate the contributing factors that led to the development of the current arsenal of techniques. It shows the trajectory for the future and provides a glimpse of the factors that that will be influential in the future.
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Affiliation(s)
- Frank Fang
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Wang K, Sears ED, Shauver MJ, Chung KC. A systematic review of outcomes of revision amputation treatment for fingertip amputations. Hand (N Y) 2013; 8:139-45. [PMID: 24426910 PMCID: PMC3653002 DOI: 10.1007/s11552-012-9487-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to conduct a systematic review of outcomes of fingertip revision amputation for fingertip amputation injuries in the English-language literature to provide best evidence of functional outcomes. METHODS A MEDLINE literature search was performed to identify studies that met the following criteria: (1) reported primary data; (2) included at least five cases of primary revision amputation treatment following digit amputation injury; (3) reported finger or thumb amputation at or distal to the distal interphalangeal (DIP) joint or interphalangeal (IP) joint, respectively; (4) presented at least one of the following outcomes: static two-point discrimination (2PD), cold intolerance, arc of motion (AOM) of metacarpophalangeal (MCP) joints, proximal interphalangeal joints (PIP), DIP joints, or return-to-work time. RESULTS Thirty-eight studies met the inclusion criteria. Twenty-seven studies reported 2PD, 20 studies reported cold intolerance, eight studies reported AOM, and 18 studies reported return-to-work time after revision amputation of fingertip injuries. The mean 2PD was 5.6 mm. On average, 24 % of patients experienced cold intolerance. AOM at the PIP joint was reported in four studies and averaged 94°. DIP joint AOM was presented in four studies and averaged 66°. Thumb MCP and IP joint AOM was presented in three and four studies, respectively. Mean thumb MCP joint AOM was 54° and that of the IP joint was 71°. The mean return-to-work time was 47 days. CONCLUSIONS On average, fingertip revision amputation can achieve almost normal sensibility and satisfactory motion and patients can expect to return to work on average approximately 7 weeks after surgery.
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Affiliation(s)
- Keming Wang
- 17th Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Erika Davis Sears
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI USA
| | - Melissa J Shauver
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI USA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340 USA ; Faculty Affairs, The University of Michigan Medical School, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340 USA
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Abstract
Over recent years, hand surgeons in the Middle East and Arabic region have particularly had to deal with an increasing number of war blast injuries to the upper extremity, in the acute, subacute and chronic phases. Many have been referred from War Zone countries such as Iraq and, more recently, Syria, where the resources to treat such complex injuries are scarce. The present article is a comprehensive review of the basic principles of management of blast injuries based on the available literature merged with the authors' personal experience of these injuries. The state of the art in treatment of blast injuries to the hand, from ammunition physics and wound ballistics to radiological investigation and, ultimately, the principles of surgical management are discussed.
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Affiliation(s)
- Joseph Bakhach
- Department of Plastic and Reconstructive Surgery, Hand and Microsurgery, American University of Beirut Medical Centre, P.O. Box 11 - 0236, Riad El-Solh, Beirut 1107 2020, Lebanon.
| | - Ghassan Abu-Sitta
- Department of Plastic and Reconstructive Surgery, Hand and Microsurgery, American University of Beirut Medical Centre, P.O. Box 11 - 0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Saad Dibo
- Department of Plastic and Reconstructive Surgery, Hand and Microsurgery, American University of Beirut Medical Centre, P.O. Box 11 - 0236, Riad El-Solh, Beirut 1107 2020, Lebanon
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Sharma PR, Ikram MS, Dickson MG. Case report: the use of a modified Tenzel-type flap to reconstruct two separate peri-ocular defects. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-011-0549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamdi M. Les lambeaux d’avancement en ilot pulpaire homodactyle des doigts longs. À propos de 32 cas. ACTA ACUST UNITED AC 2011; 30:105-9. [DOI: 10.1016/j.main.2011.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 07/06/2010] [Accepted: 02/23/2011] [Indexed: 11/16/2022]
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