Effectiveness of dorsal perforator flap of cross-finger proper digital artery in treatment of high-pressure injection injuries of the finger / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of dorsal perforator flap of cross-finger proper digital artery in the treatment of finger soft tissue defect caused by high-pressure injection injury.@*METHODS@#Between July 2011 and June 2020, 14 cases of finger soft tissue defect caused by high-pressure injection injury were repaired with dorsal perforator flap of cross-finger proper digital artery. All patients were male, with a mean age of 36 years (range, 22-56 years). The defects were located on the index finger in 8 cases, middle finger in 4 cases, and ring finger in 2 cases. The causes of injury include 8 cases of emulsion paint injection, 4 cases of oil paint injection, and 2 cases of cement injection. The time from injury to debridement was 2-8 hours, with a mean time of 4.5 hours. The soft tissue defects sized from 4.0 cm×1.2 cm to 6.0 cm×2.0 cm. The flaps sized from 4.5 cm×1.5 cm to 6.5 cm×2.5 cm. The donor site of the flap was repaired with skin graft. The pedicle was cut off at 3 weeks after operation, and followed by functional exercise.@*RESULTS@#All flaps and skin grafts at donor sites survived, and the wounds healed by first intention. Twelve patients were followed-up 16-38 months (mean, 22.6 months). The texture and appearance of all flaps were satisfactory. The color and texture of the flaps were similar to those of the surrounding tissues. The two-point discrimination of the flap was 10-12 mm, with a mean of 11.5 mm. There were different degrees of cold intolerance at the end of the affected fingers. At last follow-up, the finger function was evaluated according to the Upper Extremity Functional Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association, 3 cases were excellent, 8 cases were good, and 1 case was poor.@*CONCLUSION@#The dorsal perforator flap of cross-finger proper digital artery can effectively repair finger soft tissue defect caused by high-pressure injection injury. The operation was simple, and the appearance and function of the finger recover well.

Fingertip reconstruction: study of functional and cosmetic results of various local flaps and grafting techniques in patients attending a tertiary care center in North India

Background: Finger injuries are becoming more common with the increasing use of mechanical, industrial, and household appliances. There are six main types of repair for this injury. The replacement of skin loss in digital injuries, particularly on the volar aspects, is an important part of hand-injury management. It would be of value to know the best type of cover, especially for sensory reinnervation as well as for subjective evaluation, cosmetic appearance and freedom from complications. The objective of this study was to measure incidence of age, sex, site, pattern of injury as well as to evaluate and compare the functional and cosmetic results of the various local flap and grafting techniques in finger reconstruction distal to metacarpophalangeal joint.Methods: In a prospective study between May 2014 to October 2018 consisting of 50 patients (43 males, 7 females), aged between 2 years and 54 years, with soft tissue loss distal to metacarpophalangeal joint were treated with either free split-thickness skin grafts, palmar flaps, cross-finger flap or pedicle flaps from the abdomen. The follow-up period ranged from 10 days to 15 months from the date of surgery. Subjective and objective evaluation was done and graded as excellent, good, fair and poor.Results: In this series there were 2 good and 6 fair results for split skin grafting; 9 good and 6 fair results for v-y plasty; 5 excellent, 12 good and 4 fair results for cross finger flap; 1 good and 1 fair result for radial artery based flap; 1 excellent and 1 good for first metacarpal artery based flap and 2 good results for abdominal flap. Overall 6(12%) had excellent, 27(54%) had good and 17(34%) had fair results. None of them had poor results.Conclusions: The group of patients with cross-finger flaps had less subjective complaints and more normal objective testing results than the other groups. When an extensive tactile pad avulsion exists, the cross-finger pedicle flap offers the best long-term result with fewer secondary problems. The exclusive use of any one method cannot be advocated since each serves an useful purpose under proper conditions.

Clinical efficacy of a narrow pedicle cross-finger flap in treatment of distal fingertip degloving injuries / 中华医学美学美容杂志

Objective To investigate the application of a narrow pedicle cross-finger flap in the treatment of fingertip degloving injuries.Methods Between June 2011and May 2013,23 patients (23 fingers) suffered from fingertip degloving injuries were treated with a narrow pedicle cross-finger flap.There were 15 males (15 fingers) and 8 females (8 fingers).Defects were caused by machine crush injury in 11 cases,girdle crush injury in 7 cases and punch press injury in 5 cases.The defects were located on the index finger in 10 cases,long finger in 2 cases,ring finger in 7 cases,and little finger in 4 cases.The flaps sized 2.6 cm × 1.9 cm to 6.5 cm × 2.2 cm.After six months,according to Zhang's curative effect satisfaction score method,the efficacy of the treatment was evaluated by five aspects of skin flap healing:flap fleeing,skin flap,flap outline,flap temperature and donor site scar.Results The island flaps were survived completely in 23 patients.After followed-up for 6 to 18 months (one case was lost to follow-up).The color and texture of the flap were the same to the surrounding normal skin,and the finger shape was satisfactory.There was no pigmentation and contraction relapse ofthe injured finger.The mean values of static 2-point discrimination were (6.1 ± 1.3) mm (range,5-8 mm) of the flap.Conclusions The narrow pedicle cross-finger flap can be used to repair the fingertip degloving injuries with the flexible flap design and reliable blood supplement.The flap survives well and the repair area is good.Therefore,it is a good method and strongly recommended for fingertip degloving injuries repair in clinics.

Basosquamous Carcinoma of the Hand in a Radiologist with Prolonged Radiation Exposure

Basosquamous carcinoma is a rare epithelial neoplasm, mostly occurring on the head and neck area. There are few reports of basosquamous carcinoma on the finger. Here, the authors experienced treatment of basosquamous carcinoma on the finger in a radiologist. Treatment was successful by the wide excision and the cross-finger flap operation with a split-thickness skin graft and K-wire fixation. The rare finger basosquamous carcinoma case in our study is likely to be linked with radiation. Considering of the high reliance of C-arm during hand surgeries, we think that the hand of the surgeons should be more strictly protected.

Comparison of repair distal soft tissue defect with two kind of reverse digital artery island flaps / 中华显微外科杂志

ObjectiveTo analysis the clinic outcome(similarities & differences, indication and caution)of repairing fingertip soft tissue defect with two kind of reverse digital artery island flaps with the palmar cutaneous branch of proper digital nerve.MethodsFrom January 2000 to Auguest 2008, all 500cases (514 fingers) were repaired with reverse homodigital artery island flap (263 fingers of 250 cases) and reverse cross finger digital artery island flap(251 fingers of 250 cases).All cases were followed up from 3-8years,compared with flap range,finger extension,sensory rehabilitation,et al. ResultsAll flaps (A & Bgroup) of 500 cases (514 fingers) survived.According to flap range,cross finger flap was better than homodigital flap (P ＜ 0.05); according to finger extension,homodigital flap better than cross finger flap (P ＜0.05); according to sensory rehabilitation,homodigital flap little better than cross finger flap(P ＜ 0.05); according to long-term follow-up, all had no obviously different (P ＞ 0.05).ConclusionHomodigital flap can cover distal soft tissue defect less than 2.0 cm× 2.5 cm, cross finger flap is a better choice for more than 2.0cm×3.0cm of distal soft tissue defect. According to the flap cover area, cross finger flap is first choice,and to finger extension & sensory rehabilitation,homodigital flap is first choice; accoding to finger movements,two kinds of flaps are all good choice.

Correction of Long Standing Proximal Interphalangeal Flexion Contractures with Cross Finger Flaps and Vigorous Postoperative Exercises

PURPOSE: We reviewed the results of cross finger flaps after surgical release and vigorous postoperative exercises for long-standing, severe flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. MATERIALS AND METHODS: In 9 patients, all contracted tissue was sequentially released and the resultant skin defect was covered with a cross-finger flap. The cause of the contracture was contact burn in 4, skin graft in 3, and a previous operation in 2. The mean follow-up period was 41.2 months. RESULTS: The mean flexion contracture/further flexion in the joints were improved from 73.4/87.8degrees to 8.4/95.4degrees at the last follow-up. A mean of 19.5degrees of extension was achieved with vigorous extension exercise after the operation. The mean gain in range of motion (ROM) was 79.4degrees. Near full ROM was achieved in 3 cases. There were no major complications. CONCLUSIONS: In severe flexion contractures with scarring of the PIP joints of fingers, cross finger flaps after sufficient release and vigorous postoperative exercise seems to be a reasonable option to obtain satisfactory ROM of the joints.

An Experience with the Innervated Cross / 대한정형외과학회잡지

Sensation is the key element that allows the fingertip to participate effectively in virtually all hand functions. Therefore, it is very important to restore sensation as well as well padded, durable skin coverage following severe fingertip injuries. Many ingenious operations have been described to provide the fingertip with sensate coverage. Among them, the innervated cross-finger flap, reported by Cohen et al. in 1983, is very effective and successful in reconstruction of severe fingertip injuries, We report five cases of severe fingertip injuries treated with innervated cross-finger flap. The results are as follows : 1. The level of sensory return and the functional result is excellent in those fingertips reconstructed with the innervated cross-finger flap. 2. Mean time for flap detachment is 16 days post operative and local anesthesis at outpatient department is sufficient. 3. Four of five treated patients achieved excellent sensibility with measurable two-point discrimination(mean 5.0 mm) and ability to recongnize textures and objects.