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Zhang YF, Xing CM, Chen QZ, Gong YP. Reverse dorsolateral proximal phalangeal island flap: Long-term results. HAND SURGERY & REHABILITATION 2024; 43:101680. [PMID: 38431045 DOI: 10.1016/j.hansur.2024.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES This study aims to present long-term follow-up results of the reverse dorsolateral proximal phalangeal island flap designed for reconstruction of large fingertip and pulp defects. METHODS We examined 18 patients who underwent reverse dorsolateral proximal phalangeal island flap surgery to address ≥2.5 cm fingertip and pulp defects. Mean follow-up was 84.4 months. Sensitivity assessments were conducted using the Semmes-Weinstein monofilament and 2-point discrimination tests. Additionally, we evaluated finger joint active range of motion, complications and cold intolerance. RESULTS Mild venous congestion was observed in 5 flaps. Significant differences were observed in 2-point discrimination and Semmes-Weinstein monofilament tests between the injured and contralateral sides, specifically in the flaps, the dorsal side of the middle phalanx, and the donor site. The flap's mean static 2-point discrimination was 8.3 mm. Restricted distal interphalangeal joint extension was observed in 2 cases. Total active motion with the flap was good or excellent in the injured fingers, but with a significant difference between injured and contralateral fingers. Additionally, 42% of the injured fingers exhibited hook nail deformity, and 2 patients reported cold intolerance. Despite these issues, most patients has high scores for the appearance and satisfaction aspects of the Michigan Hand Outcomes Questionnaire. CONCLUSION In moderate or larger fingertip defects, the reverse dorsolateral proximal phalangeal island flap serves as an alternative for reconstructing both fingertip and pulp issues. However, this option involves sacrificing some sensation in the dorsum of the middle phalangeal finger and the donor area. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Yang Fan Zhang
- Department of Orthopedic Surgery, Jingmen Central Hospital, Jingmen, Hubei, 448000, PR China; Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Jiangsu, 226001, PR China
| | | | - Qing Zhong Chen
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Jiangsu, 226001, PR China.
| | - Yan Pei Gong
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Jiangsu, 226001, PR China
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Chen K, Yang S, Cheng Y, Xiang W, Zhang J, Shen J, Tang C. Reverse homodigital artery versus reverse dorsal homodigital island flaps for fingertip defect repair: A meta-analysis. J Plast Reconstr Aesthet Surg 2023; 82:237-246. [PMID: 37201315 DOI: 10.1016/j.bjps.2023.04.015] [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: 08/30/2022] [Revised: 02/17/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE This review aimed to systematically and comprehensively compare the effectiveness and applicability of reverse homodigital artery island flaps (RHAIF) and reverse dorsal homodigital island flaps (RDHIF) to treat fingertip defects. METHODS A comprehensive search was conducted in multiple databases for studies that compared RHAIF versus RDHIF for treating fingertip defects with no language restrictions from inception until July 31, 2022. A meta-analysis was performed using RevMan 5.4 software. RESULTS A total of 14 articles were retrieved, comprising 484 patients (509 fingers) in the RHAIF group and 453 patients (484 fingers) in the RDHIF group. The pooled estimates suggested that patients treated with RHAIF experienced more donor-side complications and less postoperative venous crisis than patients in the RDHIF group. On the other hand, no significant differences were found in operative time, flap necrosis, static 2-point discrimination, moving two-point discrimination, total active motion, satisfaction rates and sensory recovery grade (S3+ to S4) between the RHAIF and RDHIF groups. CONCLUSIONS No difference in effectiveness was found between the two surgical procedures for treating fingertip defects. Accordingly, the selection of the optimal approach should be based on the functional requirements of the patient and the surgeon's expertize.
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Affiliation(s)
- Keyi Chen
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
| | - Shun Yang
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
| | - Yabo Cheng
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
| | - Wang Xiang
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
| | - Jing Zhang
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
| | - Jingshou Shen
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
| | - Chenxi Tang
- Department of Hand and Wrist Surgery, Sichuan Province Orthopaedic Hospital, Chengdu, Sichuan 610000, China.
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Cutaneous Perforators and Their Clinical Implications on Intrinsic Hand Flaps: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4154. [PMID: 35475281 PMCID: PMC9029897 DOI: 10.1097/gox.0000000000004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/09/2022]
Abstract
Background: Most hand flaps are local intrinsic flaps because hand perforators are small and fragile. The purpose of this review was to gather anatomical data on cutaneous perforators of the hand and their implications on intrinsic hand flaps. Methods: An electronic search was performed through PubMed, Scopus, ScienceDirect, ProQuest, and CINAHL in April 2021. The search terms included “hand,” “palm,” “manus,” “cutaneous artery,” “angiosome,” and “perforasome.” Studies were filtered according to the PRISMA flow chart, and critically appraised using the Quality Appraisal for Cadaveric Studies (QUAC) and Appraisal Tool for Cross-sectional Studies (AXIS). Results: A total of 33 studies were included, of which 20 were pure anatomical studies, 10 combined anatomical and clinical studies, and three imaging-based clinical studies. A total of 643 hands and 406 fingers were included. The dorsal aspect of the hand, the dorsal digits, hypothenar, midpalm, thenar, and dorsal wrist consistently have adequate, closely distributed perforators of small diameters and short pedicle lengths. A series of clinical studies proved the success of elevating local perforator flaps on each of these areas. Conclusions: The hand contained densely interlinked cutaneous perforators of varying sizes and pedicle lengths. Although some areas of the hand are still unexplored, knowledge on cutaneous perforators of the hand allows the creation of a variety of possibilities for intrinsic hand flap designs.
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Bilateral flaps based on the dorsal branches of the proper digital artery: A reliable reconstruction in one-stage for the multiple defects in one finger. Injury 2021; 52:532-536. [PMID: 33023742 DOI: 10.1016/j.injury.2020.06.035] [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: 04/13/2020] [Accepted: 06/21/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To repair multiple skin soft tissue defects of one finger is a challenge to hand surgeons. We introduce a method which can be used to repair multiple skin soft tissue defects of one finger with bilateral flaps in parallel pattern flap based on the dorsal branches of the proper digital artery. METHOD A patient suffered electric injury in her left index finger with two soft tissue defects, and the areas were 1.6 cm × 1.0 cm and 2.2 cm × 1.2 cm, respectively. And who underwent a homodigital parallel flaps based on the dorsal branches of the proper digital artery to repair in January 2018. The donor sites were covered by full-thickness skin grafting. RESULTS The flaps and the skin grafting survived uneventfully. All incisions achieved primary healing. The follow-up was 19 months, and the shape of the flaps was satisfactory with soft texture and suitable appearance. TAM of the injured finger was 210°, the level was excellent. The score of VAS was 9. CONCLUSION The homodigital bilateral flaps in parallel pattern based on the dorsal branches of the proper digital artery are a potential treatment in one-stage for multiple skin soft tissue defects of one finger with reliable blood supply, satisfactory results and simple surgical procedure.
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Qin H, Ma N, Du X, Kong J, Wang H, Xu L, Hu B. Modified homodigital dorsolateral proximal phalangeal island flap for the reconstruction of finger-pulp defects. J Plast Reconstr Aesthet Surg 2020; 73:1976-1981. [PMID: 32883614 DOI: 10.1016/j.bjps.2020.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 06/01/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Reconstruction of finger-pulp defects remains a challenge, although the treatment varies widely. The homodigital island flap based on dorsal branches of the proper digital artery (PDA) is one of the most popular methods for repair of finger-pulp defects. The aim of this study was to introduce our experiences of using modified dorsolateral proximal phalangeal island flaps for reconstruction of finger-pulp defects. METHODS From July 2016 to November 2018, 16 modified dorsolateral proximal phalangeal (MDPP) island flaps were performed for finger-pulp reconstruction. The comparison group included 11 patients treated with homodigital dorsal perforator (HDP) flaps. Flap survivals were assessed and active range of motion (ROM) of the joints, time to return to work, static 2-point discrimination and hand performance were analysed at final follow-up. RESULTS Both the Group MDPP and the Group HDP had similar satisfactory flap survival. There were no differences in static 2-point discrimination, time to return to work and the ROM of the injured fingers. However, the Michigan Hand Outcomes Questionnaire (MHQ) summary scores of the satisfaction and aesthetics were much better in Group MDPP. CONCLUSIONS The modified homodigital dorsolateral proximal phalangeal island flap is a reliable alternative for finger-pulp reconstruction with good functional and cosmetic outcome.
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Affiliation(s)
- Hongjiu Qin
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan Road, Wuhu, Anhui, China
| | - Nengfeng Ma
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan Road, Wuhu, Anhui, China
| | - Xing Du
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan Road, Wuhu, Anhui, China
| | - Jian Kong
- Department of Orthopedics, Nantong Maternity and Child Health Care Hospital, No. 399 Shiji Road, Nantong, Jiangsu, China
| | - Haisheng Wang
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan Road, Wuhu, Anhui, China
| | - Lei Xu
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan Road, Wuhu, Anhui, China
| | - Bin Hu
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan Road, Wuhu, Anhui, China.
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Qin H, Ma T, Xia J, Zhang W. Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle. Arch Orthop Trauma Surg 2020; 140:987-992. [PMID: 32367376 DOI: 10.1007/s00402-020-03467-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The reverse homodigital dorsoradial flap remains a useful alternative for covering thumb defects. However, the description of pedicle width of dorsoradial flap is not clear. The aim of this study was to compare the results of narrow pedicle with wide pedicle in dorsoradial flaps and describe our experience with the thumb reconstruction. MATERIALS AND METHODS From July 2014 to February 2019, 42 patients were treated with the reverse dorsoradial flap for thumb reconstruction. The patients were divided as Group A (pedicle width ≤ 0.8 cm) and Group B (pedicle width > 0.8 cm). Flap survival, time to return to work, flap sensibility, the range of motion (ROM) of the joints, and final aesthetic outcomes were evaluated. RESULTS Respectively in the Group A (17 cases) and Group B (25 cases), 14-19 flaps survived uneventfully, whereas 3-6 flaps experienced venous congestion with no or partial flap loss. No significant difference was identified between the two groups for the incidence of venous congestion, static 2-point discrimination and ROM of the injured thumbs. Time to return to work was significantly shorter in Group A. The aesthetic satisfaction of the patients in Group A was significantly better comparing with that in Group B. CONCLUSIONS The reverse homodigital dorsoradial flap with narrow pedicle width is associated with more favorable outcomes in terms of time lost from work and aesthetic satisfaction of the patients.
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Affiliation(s)
- Hongjiu Qin
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Tao Ma
- Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Jiang Xia
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, China
| | - Wenxian Zhang
- Department of Orthopedics, Gansu Provincial Hospital of TCM, Lanzhou, 730000, Gansu, China.
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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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Gu JX, Regmi S, Zhang NC, Liu HJ, Zhang WZ, Xu T. Second toe microsurgical free-flap for aesthetic and sensory reconstruction of palmar soft tissue defects of fingers. J Plast Reconstr Aesthet Surg 2015; 69:323-7. [PMID: 26546110 DOI: 10.1016/j.bjps.2015.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 06/08/2015] [Accepted: 10/13/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To illustrate the surgical methods and clinical efficacy of microsurgical free-flaps obtained from second toe for the reconstruction of palmar soft-tissue defect of fingers. METHODS We enrolled 22 patients (13 men and 9 women), who received second toe free-flap for 22 finger defects between August 2007 and July 2013. The average age was 35 years (range, 18-62 years). The average size of flap was 2.7 cm × 2.0 cm (range, 1.5 cm × 1.5 cm-3.5 cm × 2.5 cm). RESULTS All flaps survived well without any complications. Follow-up period ranged from 8 to 30 months (mean 15 months). The Visual Analog Scale for flap appearance (VAS flap) was ranged from 8 to 10 (average, 9.5). Based on the CISS questionnaires, 6 cases had mild cold intolerance. The average value of Michigan Hand Outcome Questionnaire (MHOQ) scoring for overall hand function was 8 (range, 5-13). The sensibility outcomes in 10 patients who underwent nerve repair were satisfactory. Average value of static two point discrimination (2PD) was 6.4 mm (range, 4-10 mm) and SWM test was 3.45 (range 2.83-4.12). CONCLUSIONS Second toe free micro-flap is a very useful and reliable alternative for the reconstruction of palmer soft-tissue defect of fingers. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jia-xiang Gu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China.
| | - Subhash Regmi
- College of Medicine, Yangzhou University, 11th Huaihai Road, Yangzhou City, Jiangsu Province, 225009, PR China
| | - Nai-chen Zhang
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
| | - Hong-jun Liu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
| | - Wen-zhong Zhang
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
| | - Tao Xu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, Jiangsu Province, 225001, PR China
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The Dorsal Homodigital Island Flap Based on the Dorsal Branch of the Digital Artery. Plast Reconstr Surg 2014; 133:519e-529e. [DOI: 10.1097/prs.0000000000000016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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