A reverse dorsoradial pedicled flap from the thumb for a soft tissue defect in the finger

Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle

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.

[Repair of thumb defects with modified radial dorsal fasciocutaneous flap of thumb]

Objective

To investigate the operative method of repairing soft tissue defect of the thumb with modified radial dorsal fasciocutaneous flap and its effectiveness.

Methods

Between June 2015 and December 2016, 15 patients with volar or dorsal defects of the thumb were treated with modified radial dorsal fasciocutaneous flaps which distal pedicles were cut off. Of 15 cases, 11 were male and 4 were female, aged 35-70 years (mean, 46 years). The causes of injury included crush injury in 12 cases and avulsion injury in 3 cases. Because all patients had volar or dorsal defects of the thumb which were accompanied by tendon or bone exposure, they had no condition or desire to replant. There were 12 cases of volar defect of thumb and 3 cases of dorsal defect. The area of defects ranged from 2.0 cm×1.2 cm to 3.0 cm×2.5 cm. The time between injury and operation was 16 hours to 2 days (mean, 30.4 hours). The radial dorsal fascio-cutaneous flaps of 2.3 cm×1.5 cm to 3.3 cm×2.8 cm in size were adopted to repair defects. The donor sites were directly sutured.

Results

All flaps survived, and no severe swelling or tension blister occurred. The donor sites and wounds healed by first intention. All patients were followed up 3-12 months (mean, 6 months). The color and texture of the grafted flaps were similar to those of normal skin, with no bloated appearance. According to total active motion standard at last follow-up, the finger function was excellent in 8 cases and good in 7 cases.

Conclusion

Modified radial dorsal fasciocutaneous flap of the thumb is a reliable flap with easy dissection and less trauma in repair of soft tissue defects of the thumbs, and satisfactory clinical outcome can be obtained.