1
|
Yu W, Yin C, Liu W, Wei S, Yang G, Shen X. Revision of residual deformities after primary surgery for Wassel-Flatt IV-D thumb duplication using a microsurgical free lateral great toe flap. J Hand Surg Eur Vol 2024:17531934231222400. [PMID: 38180906 DOI: 10.1177/17531934231222400] [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] [Indexed: 01/07/2024]
Abstract
We report the application and results of skin defect coverage using the free lateral great toe flap in revision surgery for residual postoperative deformities in Wassel-Flatt type IV-D thumb duplications. This retrospective study included five patients treated between June 2020 and September 2021 to correct angular deformity and repair the secondary skin defect. All the flaps survived. The patients were followed up for 8-12 months and all the reconstructed thumbs had a satisfactory appearance. The results of the Japanese Society for Surgery of the Hand scoring system were excellent in one patient, good in three patients and fair in one patient. The results of the Alignment, Ulnar and Radial stability, Range of motion and Aesthetical aspects (ALURRA) scoring system were good in four patients and moderate in one patient.Level of evidence: IV.
Collapse
Affiliation(s)
- Wentao Yu
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chunhua Yin
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Liu
- Department of Pediatric Plastic Surgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Song Wei
- Department of Pediatric Plastic Surgery, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guang Yang
- Department of Hand Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaofang Shen
- Department of Pediatric Orthopaedics, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
2
|
Shi H, Huang Y, Wu K, Shen Y, Su X, Zhang Z. Sensory re-education after free neurovascular toe pulp flap for digital pulp reconstruction. J Plast Reconstr Aesthet Surg 2024; 88:407-413. [PMID: 38086326 DOI: 10.1016/j.bjps.2023.11.037] [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: 06/15/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/02/2024]
Abstract
PURPOSE To evaluate the effectiveness of a sensory re-education (SR) program after free neurovascular toe pulp flap for finger or thumb pulp defect reconstruction. METHODS From January 2015 to January 2020, 49 patients with finger or thumb pulp defects treated with free fibular side flaps of the great toe or tibial side flaps of the second toe were recruited. The patients were randomly divided into two groups one month after surgery. The training group received the SR program, and the control group underwent the traditional rehabilitation program. Clinical evaluation included Semmes-Weinstein Monofilament (SWM) tests, static two-point discrimination (2-PD), and sensibility grading, measured at 1, 3, 6, 9, and 12 months postoperatively. RESULTS A total of 42 patients completed the follow-up, including 22 (16 males) patients in the training group and 20 patients (12 males) in the control group. Compared with 1 month after the operation, significant improvements in sensory recovery were observed at 3, 6, 9, and 12 months postoperatively in both groups. In addition, earlier sensory recovery was seen in the SR group compared to the control group, showing significant differences at 3 and 6 months but not at 9 and 12 months postoperatively. CONCLUSION Although SR seemed to accelerate preliminary sensory recovery after free neurovascular toe pulp flaps for digital defect reconstruction, the program should be reconsidered as it offers no significant improvement over the control group at later follow-up stages.
Collapse
Affiliation(s)
- Haifeng Shi
- Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China.
| | - Yongjing Huang
- Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Ke Wu
- Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Yong Shen
- Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Xubei Su
- Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Zhihai Zhang
- Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| |
Collapse
|
3
|
Li J, Wu H, Zhang Y, Jin G, Wang K, Zhang G, Ju J. The modified second toe flap technique based on the dorsal digital artery of the toe in finger pulp reconstruction. Microsurgery 2023; 43:580-587. [PMID: 37309237 DOI: 10.1002/micr.31073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/09/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND The second toe flap is a widely used innervated neurovascular flap for repairing finger pulp defects. It mainly carries the proper plantar digital artery and nerve. But the donor site morbidity and arterial injury are common. The report retrospectively evaluated the clinical outcomes of the second toe free medial flap based on dorsal digital artery of the toe to investigate the esthetics and function in the treatment of soft tissue defects of fingertip pulp. METHODS From March 2019 to December 2020, 12 patients with finger pulp defects (seven acute crush, three cut, and two burn) undergoing the modified second toe flap were chosen for retrospective review. The average patient age was 38.6 (range: 23-52) years. The mean defect size was 2.1 × 1.6 (range: 1.5 × 1.3-2.6 × 1.9) cm. The defects did not extend beyond the distal interphalangeal joint and the phalanges were not damaged in all cases. The average follow-up was 9.5 (range: 6-16) months. Demographic information, flap data, and perioperative characteristics were collected. RESULTS The mean size of the modified flap was 2.3 × 1.8 (range: 1.7 × 1.5-2.7 × 2.0) cm and mean diameter of artery was 0.61 (range: 0.45-0.85) mm. The mean flap harvested time and operation time were 22.6 (range: 16-27) minutes and 133.7 (range: 101-164) minutes. A flap was ischemic after first day postoperatively and later it improved by releasing the sutures. All flaps were survival without necrosis. One patient was not satisfied with the appearance of the finger pulp because of scar hyperplasia. The other 11 patients were satisfied with the appearance and function of the injured digit after 6 months postoperatively. CONCLUSION The modified second toe flap technique based on the dorsal digital artery of the toe is a feasible choice to reconstruct the sensation and appearance of the injured fingertip with current microsurgical techniques.
Collapse
Affiliation(s)
- Jin Li
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Haibo Wu
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Yan Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Guangzhe Jin
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Kai Wang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Guangliang Zhang
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| | - Jihui Ju
- Department of Hand Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou, Jiangsu, China
- Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China
| |
Collapse
|
4
|
Evin N, Evin SG, Guneren E. Composite classification and algorithmic reconstruction of fingertip defects with free lateral great toe flaps. J Plast Reconstr Aesthet Surg 2023; 80:133-144. [PMID: 37023598 DOI: 10.1016/j.bjps.2023.02.010] [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: 08/23/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND This study aimed to classify fingertip defects according to dimensions and composite content, and present algorithmic reconstruction results with free lateral great-toe flaps. METHODS A total of 33 patients who underwent reconstruction for full-thickness defects of fingertips with free lateral great-toe flaps were retrospectively reviewed. Patients were divided into four groups by the algorithm according to the dimension and content of defects. Functional disabilities of the upper extremities, limitations of donor feet, finger cosmetics, sensory recovery, and pinch power were evaluated using the disabilities of the arm, shoulder and hand, foot function index, 5-point Likert satisfaction scales, Semmes-Weinstein monofilament and static 2-point discrimination tests, and pulp pinch-strength test, respectively. RESULTS The standardized distribution of patients according to dimensions and content of defects was achieved. When the composite content of defects increase such as group 4, complex surgical skills are required, duration of surgery is extended, return to work is delayed, and donor-site complications are increased. Functional limitations of the hands improved normally after reconstruction (p < 0.00). Sensory recovery of flaps was normal and test scores were strongly correlated (p = 0.78). All patients and observers were satisfied with finger's cosmetics. CONCLUSION Our classification and reconstruction algorithm is simple and easy to apply for all fingertip defects without complicated reference points, and it provides information about the surgical and post-surgical periods. When the dimension and composite deformities of the defect increase through groups 1-4, more complex reconstruction, increased donor-site complications, prolonged duration of surgery, and delayed return to work are observed.
Collapse
Affiliation(s)
- Nuh Evin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey.
| | - Seyda Guray Evin
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Ethem Guneren
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
5
|
Yuan C, Wang S, Wang Y, Ding W, Shen H, Gu J. Reverse digital artery island flap with versus without sensory nerve coaptation for finger pulp reconstruction. ANZ J Surg 2023; 93:281-287. [PMID: 36453612 DOI: 10.1111/ans.18180] [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: 10/16/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Whether an innervated reverse digital artery island flap is superior to a non-innervated reverse digital artery island flap still remains controversial. We aimed to compare the clinical outcomes of the two flaps in repairing finger pulp soft tissue defects. METHODS Medical records of patients who underwent finger pulp reconstruction between January 2007 and December 2017 were evaluated retrospectively. A total of 45 patients were included. Twenty underwent sensory nerve reconstruction with cutaneous branches of the proper digital nerve, and 25 underwent the surgery without sensory nerve reconstruction. Surgical results, complications and sensory function were collected for analysis. Sensory function was assessed by static two-point discrimination and the modified sensory evaluation standard of British Medical Research Council. RESULTS The average operation time of innervated flaps was 23 min longer than non-innervated flaps. All 45 flaps survived completely. There was no significant difference in complications between groups. The average follow-up was 22 months. At the final follow-up, five non-innervated flaps had no recovery of static two-point discrimination. The average static two-point discrimination of the remaining 20 non-innervated flaps was larger than that of innervated flaps. Innervated flaps consistently achieved higher sensory function grades according to the modified sensory evaluation standard of British Medical Research Council. CONCLUSION An innervated reverse digital artery island flap can achieve better sensory function recovery in a shorter time. This procedure did not increase the incidence of complications, although it extended the operation time. It has proven to be a good technique for finger pulp reconstruction.
Collapse
Affiliation(s)
- Chaoqun Yuan
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Shuang Wang
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yang Wang
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Wenqiang Ding
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Haobo Shen
- The First Clinical College, Dalian Medical University, Dalian, China
| | - Jiaxiang Gu
- Department of Hand and Foot Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| |
Collapse
|
6
|
Tailored Skin Flaps for Hand Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4538. [PMID: 36203738 PMCID: PMC9529032 DOI: 10.1097/gox.0000000000004538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
|
7
|
To Do or Not to Do? Neurorrhaphy in Great Toe Pulp Flap Fingertip Reconstruction. Plast Reconstr Surg Glob Open 2022; 10:e4539. [PMID: 36203734 PMCID: PMC9529029 DOI: 10.1097/gox.0000000000004539] [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: 04/28/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022]
Abstract
Since its inception, the great toe pulp (GTP) flap has represented a valid therapeutic choice in the reconstruction of defects of the hand. This study illustrates the clinical outcomes of GTP free flaps performed without nerve anastomosis' mainly for fingertip defect reconstruction. Methods We performed a retrospective, monocentric cohort study. All patients included in this study presented with fingertip traumatic injury, with tendon or bone exposure; reconstruction with GTP flap, without nerve reconstruction, was performed by the first author (L.T.) from May 2019 to October 2021. Results All 37 flaps survived completely. Due to COVID restrictions' we had to send the tests and PROMs to our patients; 28 of them replied. Cold intolerance was reported by 12 patients (moderate in two cases and mild in ten cases). No pain was complained about either in hand or donor site (Visual Analog Score 0, at rest and at movement). Complete range of motion was achieved in 22 of 28 patients. All flaps recovered protective sensitivity. In every section of the Michigan Hand Outcome Questionnaire, all patients expressed a high level of satisfaction based on the reconstruction's function and aesthetics. Regarding the donor site morbidity, no patient complained about gait disturbance. Conclusions This study showed that the GTP flap is the optimal choice for fingertip reconstruction, providing excellent functional and aesthetic results with durable and glabrous skin, satisfactory pulp contour, and sensory restoration. These results could be achieved with no need for nerve suture, especially in defects with no injuries proximal to the loss of substance.
Collapse
|
8
|
Tatar BE, Sabancıoğullarından F, Gelbal C, Bozkurt M. Use of Heparin Cream for Venous Congestion in the Extended Reverse Metacarpal Artery Flap: A Case Report. Arch Plast Surg 2022; 49:663-667. [PMID: 36159369 PMCID: PMC9507599 DOI: 10.1055/s-0042-1756344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.
Collapse
Affiliation(s)
- Burak Erguün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Fahri Sabancıoğullarından
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Caner Gelbal
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Bozkurt
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Yuan C, Liu H, Zhang H, Wang T, Gu J. Reconstruction of Thumb Pulp Defects Using Free Lateral Great Toe Flaps. J Hand Surg Am 2021; 46:421.e1-421.e7. [PMID: 33191037 DOI: 10.1016/j.jhsa.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/29/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the risk factors for, and clinical outcomes of, free lateral great toe flaps for the reconstruction of thumb pulp defects. METHODS Between January 2009 and July 2017, 31 patients with thumb pulp defects were treated with free lateral great toe flaps. Seven patients were lost to follow-up. We included 9 female and 15 male patients, average age 35 years. We performed a retrospective review of risk factors, clinical outcomes, and complications. For patients in which the flap survived, we assessed postoperative range of motion, static 2-point discrimination, Semmes-Weinstein monofilament test, Michigan Hand Outcomes Questionnaire, time of return to work, and cold intolerance severity score. RESULTS Of 24 flaps, 20 survived completely. Smoking was found to be a potential risk factor for flap necrosis. Average follow-up of the 20 patients in whom the flap survived was 20 months (range, 12-24 months). At final follow-up, all patients were satisfied with recovery in terms of function and aesthetic appearance. No patient required additional aesthetic refinement procedures. Complications occurred in 6 patients and consisted of venous congestion, superficial infection, and deep infection. CONCLUSIONS Lateral great toe flap transfer in the reconstruction of thumb pulp defects has proven to be a good technique with overall satisfactory outcomes. Smoking increases the risk for flap necrosis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Chaoqun Yuan
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China; Nanjing Medical University, Nanjing, China
| | - Hongjun Liu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hanyu Zhang
- Department of Emergency Medicine, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Tianliang Wang
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jiaxiang Gu
- Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.
| |
Collapse
|
10
|
Fulchignoni C, Rocchi L, Cauteruccio M, Merendi G. Matriderm dermal substitute in the treatment of post traumatic hand's fingertip tissue loss. J Cosmet Dermatol 2021; 21:750-757. [PMID: 33786967 DOI: 10.1111/jocd.14115] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Treatment of fingers tissue loss is particularly challenging as it often necessitates advanced reconstructive techniques such as flaps or grafts, with esthetic and functional results that are not always as good as hoped for, with long healing times. Recently, along with tissue engineering development, numerous types of dermal substitute have been commercialized, with promising possibilities of treatment in finger tissue loss. In the author's unit, Matriderm® is the most commonly used dermal substitute. As described by the manufacturer, this scaffold is designed to be covered with a split-thickness skin graft. In using a two-step procedure, the authors realized that in most cases of fingertips injuries, at three weeks follow-up, the wound appeared in an advanced state of healing, which permitted to avoid grafting. MATERIAL AND METHODS Between October 2017 and October 2018, 27 fingers have been included in this study. Patients have been divided in two groups: those treated with Matriderm® alone (15 fingers) and those who had a skin graft three weeks after the first surgery (12 fingers). At the 6-month follow-up, authors evaluated the esthetic results with the Vancouver Scar Scale (VSS), the functional results with Quick Disability of the Arm, Shoulder and Hand (qDASH) score, and sensibility by the mean of two-point discrimination test (2-PD). RESULTS All outcomes were overlapping in patients treated with or without skin graft: mean VSS was 2.3, mean qDASH was 13.3, and mean 2-PD was 7.7 mm. CONCLUSIONS The results obtained allow to consider Matriderm® , used also without skin graft coverage, as a valid solution for treatment of fingertip tissue loss.
Collapse
Affiliation(s)
- Camillo Fulchignoni
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Lorenzo Rocchi
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Michele Cauteruccio
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Gianfranco Merendi
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Roma, Italia
| |
Collapse
|
11
|
Hong MK, Park JH, Koh SH, Lee DC, Roh SY, Lee KJ, Kim JS. Microsurgical Free Tissue Options for Fingertip Reconstruction. Hand Clin 2021; 37:97-106. [PMID: 33198921 DOI: 10.1016/j.hcl.2020.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fingertip injuries occur commonly owing to trauma in everyday life. Performing amputation or stump revision for a fingertip injury can make it possible to quickly return to daily life, but causes functional and cosmetic problems. We believe that free flaps are the ideal way to minimize donor site morbidity and provide satisfactory reconstruction. Fingertips have different anatomic characteristics on the dorsum, volar aspect, and pulp, so it is necessary to select the appropriate free flap. Sometimes for larger defects, composite tissue transfer can be considered for reconstruction. This article discusses various free flap options for different fingertip defects.
Collapse
Affiliation(s)
- Min Ki Hong
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea
| | - Jin Ha Park
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea
| | - Sung Hoon Koh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea
| | - Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea
| | - Si Young Roh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea
| | - Kyung Jin Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea
| | - Jin Soo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36 Digital-ro, Gwangmyeong 14241, South Korea.
| |
Collapse
|
12
|
Lateral Toe Pulp Flap Used in Reconstruction of Distal Dorsal Toe Defect: Case Report and Review of the Literature. Ann Plast Surg 2020; 82:S136-S139. [PMID: 30461456 DOI: 10.1097/sap.0000000000001703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND When the distal dorsal part of the great toe is injured, especially with exposure of a tendon, bone, or joint, applying a free or local flap is difficult because of the lack of locally available tissue for reconstruction. Management of the distal dorsal part of a great toe soft tissue defect can be challenging for plastic surgeons. PATIENT AND METHOD An 18-year-old woman presented with an injury to the dorsal aspect of her right great toe caused by a cobra bite. After fasciotomy, the wound showed exposure of the extensor hallucis longus tendon. After demarcation and infection control, the wound was reconstructed using a lateral toe pulp flap of approximately 3.5 × 1.0 cm. The flap was transposed to the defect, and the donor site was closed primarily. Toe pulp flaps are mainly used to reconstruct finger pulp defects and are useful because they provide a glabrous skin flap suitable for resurfacing fingertip injuries. A lateral toe pulp flap uses a homodigital adjacent skin flap, which is transposed to cover the soft tissue defect. Using a quick and straightforward procedure, we designed this flap to reconstruct a distal dorsal defect of the great toe, with minimal morbidity at the donor site. RESULTS The flap initially showed mild congestion but survived completely. CONCLUSIONS Applying a lateral toe pulp flap is a quick, simple, and reliable 1-stage procedure. It may be an effective option in reconstructing distal dorsal defects of the great toe.
Collapse
|
13
|
Fan A, Song L, Zhang H, Gao W, Zhang X, Yu Y. Reconstruction of Finger Pulp Defects With an Innervated Distally-Based Neurovascular Flap. J Hand Surg Am 2020; 45:454.e1-454.e8. [PMID: 31810540 DOI: 10.1016/j.jhsa.2019.10.018] [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: 11/24/2018] [Revised: 07/15/2019] [Accepted: 10/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Finger pulp resurfacing is a challenging reconstructive problem. This article introduces sensory reconstruction of finger pulp defects using an innervated distally-based neurovascular flap raised from the dorsum of the thumb. METHODS From May 2015 to May 2017, the innervated distally-based neurovascular flap was used in 36 patients. The mean age at surgery was 37 years (range, 18-61 years). All patients were assessed using the total active motion (TAM) scoring system of the American Society for Surgery of the Hand. The sensitivity of the flap was tested using static 2-point discrimination. RESULTS Full flap survival was achieved in 35 cases. Partial necrosis at the distal margin of the flap was observed in 1 case. At the final follow-up (mean, 20 months; range, 18-23 months), the mean TAM of the thumb was 206° (range, 188°-238°), including 8 excellent and 28 good results. The mean TAM of fingers was 266° (range, 251°-282°), including 4 excellent and 32 good results. The mean value of static 2-point discrimination was 5 mm (range, 4-7 mm) in the flap, including 31 excellent and 5 good results. CONCLUSIONS The innervated distally-based neurovascular flap raised from the dorsum of the thumb is a reliable alternative for sensory reconstruction of finger pulp defects. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Anwei Fan
- Department of Orthopaedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China
| | - Lihua Song
- Department of Orthopaedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China
| | - Hongliang Zhang
- Department of Orthopaedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China
| | - Wenhua Gao
- Department of Orthopaedic Surgery, Orthopaedic Hospital of Xingtai, Xingtai, Hebei, China
| | - Xu Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Yadong Yu
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
14
|
Abstract
Soft tissue reconstruction of the digit is challenging for hand surgeons because it must satisfy both functional and aesthetic requirements. A wide variety of treatment options exist. A free flap can be an alternative solution in some clinical situations. This article has 2 purposes. First, it discusses various considerations for free-flap usage for reconstruction of soft tissue defects of the digits and the available options. Second, it provides more detailed information regarding the 3 commonly used free flaps, namely, the partial toe pulp flap, radial artery superficial palmar branch flap, and arterialized venous flap.
Collapse
|
15
|
Hu H, Chen H, Hong J, Mao W, Tian M, Wang L, Dong J, Li X. Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger. BMC Surg 2019; 19:188. [PMID: 31829162 PMCID: PMC6907148 DOI: 10.1186/s12893-019-0649-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022] Open
Abstract
Background When restoring the appearance and function of the fingers, hand surgeons face a challenge in choosing a suitable surgical method to repair finger skin defects. Methods In this study, we designed a long elliptical flap based on a propeller perforator flap and located slightly toward the dorsal lateral aspect of the finger. The flap with a pedicle consisting of the dorsal perforator of the distal digital artery and dorsal digital artery perforator chain is rotated to cover a large wound on the distal end. From December 2014 to December 2017, 10 patients with finger soft tissue defects were treated with the propeller perforator flap described in this study. Results All flaps survived after surgery, and 2 had a transient venous congestion. After a follow-up period of 3 to 12 months, the static two-point discrimination of the flap was 8.06 ± 1.75 mm, and the range of motion was 149.4 ± 12.9°. This designed flap can span several angiosomes supplied by the perforators. Due to the inclusion of a vessel chain between the dorsal digital artery perforators, the length-to-width ratio of the flap can be up to 3:1. Conclusions This technique increases the size of flap that can be harvested safely while retaining a reliable blood supply. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based on dorsal digital artery perforator chains. Trial registration The registration number of this study is ChiCTR1800014588; it has been retrospectively registered with Chinese Clinical Trial Registry (chictr.org.cn), 18/11/2019.
Collapse
Affiliation(s)
- Haoliang Hu
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Hong Chen
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Jinjiong Hong
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Weisheng Mao
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Mintao Tian
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China
| | - Liping Wang
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China. .,School of Pharmacy and Medical Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
| | - Jianghui Dong
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China. .,School of Pharmacy and Medical Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA, 5001, Australia.
| | - Xueyuan Li
- Department of Hand Surgery, Ningbo No. 6 Hospital, Ningbo, 315040, China.
| |
Collapse
|
16
|
Chen C, Wang ZT, Hao LW, Liu Y, Liu HL. Vascularized flap transfer to fingers with volar digital veins as recipient vessels. J Hand Surg Eur Vol 2019; 44:1019-1025. [PMID: 31403872 DOI: 10.1177/1753193419866413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Traditionally free vascularized flap transfers to the fingers connect to the proper digital artery and dorsal veins. We report our experience using the volar digital veins as recipient veins for free vascularized flap transfers in 14 fingers of 12 patients. One or two veins (three flaps with two veins, 11 flaps with one vein) of the flap were anastomosed to volar digital veins in the recipient site. The arteries of these flaps were connected to the proper digital arteries. All the transferred flaps survived. No vessel crisis occurred. Our patients demonstrated that volar veins can be the recipient veins for free flap transfers in the fingers without increased risk of venous crisis and flap loss. Level of evidence: IV.
Collapse
Affiliation(s)
- Chao Chen
- Department of Hand and Foot Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Zeng Tao Wang
- Department of Hand and Foot Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Li Wen Hao
- Department of Hand and Foot Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Yang Liu
- Department of Hand and Foot Surgery, Jinan Municipal Hospital of Traditional Chinese Medicine, Shandong, China
| | - Huan Long Liu
- Department of Hand and Foot Surgery, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
| |
Collapse
|
17
|
Balan JR, Mathew S, Kumar P, Vardhan H, Francis A, Aniljith VG, Gopal R. The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice. Indian J Plast Surg 2019; 51:54-59. [PMID: 29928080 PMCID: PMC5992930 DOI: 10.4103/ijps.ijps_37_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same. Materials and Methods: A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted. Results: All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar. Conclusions: RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.
Collapse
Affiliation(s)
- Jyoshid R Balan
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| | - Shaji Mathew
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| | - Pradeep Kumar
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| | - Harsh Vardhan
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| | - Anto Francis
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| | - V G Aniljith
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| | - Raj Gopal
- Sushrutha Institute of Plastic Reconstructive and Aesthetic Surgery, Elite Mission Hospital, Thrissur, Kerala, India
| |
Collapse
|
18
|
Chen Q, Xie Q, Pan D. Reconstruction of anterior skin loss in all four fingers using a free medial plantar flap. J Hand Surg Eur Vol 2019; 44:538-540. [PMID: 30760094 DOI: 10.1177/1753193419828317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Qiang Chen
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, PR China
| | - QingPing Xie
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, PR China
| | - DanHong Pan
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, PR China
| |
Collapse
|
19
|
Wang L, Wang HJ, Xie QP. Reconstruction of severe composite tissue defects of the hand using a composite second metatarsal flap. J Hand Surg Eur Vol 2018; 43:670-671. [PMID: 29669449 DOI: 10.1177/1753193418771302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Liang Wang
- 1 Department of Hand and Reconstruction Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.,2 People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Hui-Ju Wang
- 2 People's Hospital of Hangzhou Medical College, Hangzhou, China.,3 Clinical Research Institute, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Qing-Ping Xie
- 1 Department of Hand and Reconstruction Surgery, Zhejiang Provincial People's Hospital, Hangzhou, China.,2 People's Hospital of Hangzhou Medical College, Hangzhou, China
| |
Collapse
|
20
|
Zhu ZW, Zou XY, Huang YJ, Liu JH, Huang XJ, He B, Wang ZT. Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children. Neural Regen Res 2017; 12:1911-1917. [PMID: 29239339 PMCID: PMC5745847 DOI: 10.4103/1673-5374.219053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.
Collapse
Affiliation(s)
- Zhao-Wei Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province; Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiao-Yan Zou
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yong-Jun Huang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
| | - Jiang-Hui Liu
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xi-Jun Huang
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Bo He
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zeng-Tao Wang
- Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| |
Collapse
|