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Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects.

Zhu L, Xu Q, Kou W, Ning B, Jia T - Indian J Orthop (2014)

Bottom Line: Patients were followed up for 6-9 months.The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand and Foot Surgery, Qilu Hospital, Shandong University, Jinan, China ; Department of Orthopaedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, China.

ABSTRACT

Background: Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.

Materials and methods: Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.

Results: Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.

Conclusion: Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

No MeSH data available.


Related in: MedlinePlus

Clinical photograph showing (a) Finger tip defect (b) Flap design
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Figure 1: Clinical photograph showing (a) Finger tip defect (b) Flap design

Mentions: Six patients with fingertip defects underwent repair with free digital artery perforator flaps between March 2009 and August 2012. They were all manual workers. The fingertip defects were caused by crush injury and incised wound, with bone and tendon exposure [Figure 1a]. All flaps survived. The size of the flap ranged from 1.0 cm × 1.4 cm to 1.3 cm × 2.8 cm. No patients had postoperative hypersensibility of the repaired fingertips. This study was conducted with approval from the Ethics Committee of Qilu Hospital, Shandong, China. A written informed consent was obtained from patients or their families.


Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects.

Zhu L, Xu Q, Kou W, Ning B, Jia T - Indian J Orthop (2014)

Clinical photograph showing (a) Finger tip defect (b) Flap design
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232829&req=5

Figure 1: Clinical photograph showing (a) Finger tip defect (b) Flap design
Mentions: Six patients with fingertip defects underwent repair with free digital artery perforator flaps between March 2009 and August 2012. They were all manual workers. The fingertip defects were caused by crush injury and incised wound, with bone and tendon exposure [Figure 1a]. All flaps survived. The size of the flap ranged from 1.0 cm × 1.4 cm to 1.3 cm × 2.8 cm. No patients had postoperative hypersensibility of the repaired fingertips. This study was conducted with approval from the Ethics Committee of Qilu Hospital, Shandong, China. A written informed consent was obtained from patients or their families.

Bottom Line: Patients were followed up for 6-9 months.The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

View Article: PubMed Central - PubMed

Affiliation: Department of Hand and Foot Surgery, Qilu Hospital, Shandong University, Jinan, China ; Department of Orthopaedic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, China.

ABSTRACT

Background: Fingertip defect can be treated with many flaps such as random pattern abdominal flap, retrograde digital artery island flap, V-Y advancement flap, etc. However, swelling in the fingertip, dysfunction of sensation, flexion and extension contracture or injury in the hemi-artery of the finger usually occurs during the recovery phase. Recently, digital artery perforator flaps have been used for fingertip reconstructions. With the development of super microsurgery techniques, free flaps can be more effective for sensory recovery and durability of the fingertip.

Materials and methods: Six cases (six fingers) of fingertip defects were treated with free digital artery perforator flaps of appropriate size and shape from the proximal phalanx. During surgery, the superficial veins at the edge of flap were used as reflux vessels and the branches of the intrinsic nerve and dorsal digital nerve toward the flap were used as sensory nerves. The proximal segment of the digital artery (cutaneous branches) towards the flap was cut off to form the pedicled free flap. The fingertips were reconstructed with the free flap by anastomosing the cutaneous branches of digital artery in the flap with the distal branch or trunk of the digital artery, the flap nerve with the nerve stump and the veins of the flap with the digital artery accompanying veins or the superficial veins in the recipient site.

Results: Six flaps survived with successful skin grafting. Patients were followed up for 6-9 months. The appearance and texture of the flaps was satisfactory. The feeling within the six fingers recovered to S4 level (BMRC scale) and the two point discrimination was 3-8 mm.

Conclusion: Free digital artery perforator flap is suitable for repairing fingertip defect, with good texture, fine fingertip sensation and without sacrificing the branch of the digital artery or nerve.

No MeSH data available.


Related in: MedlinePlus