Repair of degloving injury of distal thumb with innervated reversed dorsal digital artery island flap / 中华医学美学美容杂志

Objective:To investigate the clinical outcomes of homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve to repair degloving injury of distal thumb.Methods:From July 2016 to June 2019, a total of 15 cases (15 thumbs) with degloving injury of distal part were admitted to the Department of Hand Surgery, the Second Hospital of Tangshan. Nine males and six females were involved, with an average age of 49 years (range, 41 to 69 years). There were twist injury in eight cases and crush injury in seven cases, with four cases of distal phalanx fracture. The defect dimensions after debridement ranged from 3.5 cm×1.8 cm to 4.6 cm×2.4 cm, and the dimension of the flaps ranged from 3.8 cm×2.1 cm to 5.0 cm×2.7 cm. All defects were repaired using homodigital reversed dorsal digital artery island flap innervated by the dorsal digital nerve. The survival, appearance and sensory recovery of the flaps and function of the injured fingers were observed at the follow-up after operation.Results:All the flaps survived without wound infection and blood supply disorder. The follow-up times ranged from 9 to 22 months (mean, 16 months). There was satisfactory appearance of the flaps with similar color and texture to the surrounding tissue. Fracture healing ranged from 4 to 6 weeks. At final follow-up, the values of static 2-PD test of the flaps ranged from 5 to 10 mm (mean, 7.8 mm). The results of range of motion of injured thumb joints were excellent in nine cases and good in five cases. There was slight linear scar left at the donor area of dorsal thumb.Conclusions:The innervated reversed dorsal digital artery island flap has a simple procedure and minimal donor-site cost, which is especially suitable for elderly patients who refuse to free toe transfers.

Flaps Based on Perforators of the Digital Artery.

This review article summarizes the various types of digital artery perforator flaps used in digit reconstruction. The indications for use of digital artery perforator flaps and the preferred approach for reconstructing fingertip defects are explained in this article. Recent updates in digital artery perforator anatomy in the finger, techniques for flap harvest, and inset as well as a delayed approach to using digital perforator flaps in finger reconstruction are discussed.

Applied anatomied study in bilobed micro-flap of second dorsal metacarpal artery and dorsal digital artery / 中华显微外科杂志

Objective To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal dig鄄ital artery. Methods From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected.The ra鄄dial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed. Results The distal 1/3 seg鄄ment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface.The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries.The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6 ±0.4 cm and the diameter was 0.2±0.1 mm.Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches. Conclusion The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue de鄄fect on the thumb and purlicue.

Applied anatomied study in bilobed micro-flap of second dorsal metacarpal artery and dorsal digital artery / 中华显微外科杂志

Objective@#To observe the location and the distribution of distal 1/3 segment of the second dorsal metacarpal artery, the finger web artery and the dorsal digital artery, and to provide anatomical data for repairing the soft tissue defect on the hand with bilobed or multi-lobed micro-flap with second metacarpal dorsal artery-dorsal digital artery.@*Methods@#From June, 2018 to March, 2019, 34 fresh adult upper limb specimens were selected. The radial and ulnar arteries were perfused with red latex in 24 specimens. The radial and ulnar arteries were infused with cast materials to make cast specimens in 10 specimens. The location and distribution of the distal 1/3 segment of the second dorsal metacarpal artery, the finger web and the dorsal digital artery were observed.@*Results@#The distal 1/3 segment of second dorsal metacarpal artery extended (4±1) cutaneous branches, and continued to become the finger web artery at the plane of the articular surface. The length of the finger web artery was (2.5±0.6) cm, and there were 4 types anastomic methods of communication with arteries. The second dorsal metacarpal artery extended 2 finger dorsal artery to the proximal dorsal skin of the middle finger and index finger. The length of dorsal digital artery was 2.6±0.4 cm and the diameter was 0.2±0.1 mm. Four to 6 micro-cutaneous branches were extended and consistent with the nearby skin cutaneous branches.@*Conclusion@#The distal segment of the second dorsal metacarpal artery and the dorsal digital artery is anatomically constant. The distal segment of the second dorsal metacarpal artery and dorsal digital artery are the pedicle for the design of the bilobed flap of middle finger and index finger to repair small soft tissue defect on the thumb and purlicue.

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit.

OBJECTIVE: Providing soft tissue coverage for finger neurocutaneous defects presents aesthetic and sensory challenges. A common source for reconstruction of soft tissue defects of the fingers is the same finger. However, when the donor areas are damaged by concomitant injuries, this option is not available. The present study aims to reconstruct finger neurocutaneous defects using a sensory reverse dorsal digital artery flap from the neighboring digit and to evaluate the efficacy of this technique. METHODS: The study included 16 patients, with an average age of 34.9 years (range, 20-53 years) at the time of surgery, from May 2010 to June 2013. The sensory reverse dorsal digital artery flap was used in all 16 patients, who had a combination of soft tissue and digital nerve defects. The mean size of the soft tissue defects was 3.1 cm × 2.0 cm, and the mean flap size was 3.3 cm × 2.2 cm. The length of the nerve defects ranged from 1.3 to 2.5 cm (mean, 2.0 cm), which were reconstructed with dorsal branches of the proper digital nerve transfer. The active motion of the fingers (injured and donor) and the flap sensibility (static two-point discrimination) were measured. The appearance and functional recovery of the injured finger and the donor site were assessed using the Michigan Hand Outcomes Questionnaire. RESULTS: All flaps survived completely. No complications were reported, and no further flap debulking procedure was required. At the mean follow-up period of 24 months (range, 18-30 months), the mean static two-point discrimination was 6.5 mm (range, 5-10 mm) of the reconstructed area; the mean ranges of motions of the injured finger and the opposite finger at the proximal interphalangeal and distal interphalangeal joints were 102.2° and 103.5°, and 70.3° and 76.5°, respectively. The average ranges of motions of the metacarpophalangeal and proximal interphalangeal joints of the donor fingers were 90° and 103.4°, respectively. Based on the Michigan Hand Outcomes Questionnaire, 10 patients were strongly satisfied and 6 were satisfied with the functional recovery of the injured finger; however, 13 patients were strongly satisfied and 3 were satisfied with the appearance of the injured finger. CONCLUSION: The sensory reverse dorsal digital artery flap from the neighboring digit, based on the dorsal branch of the digital artery, is an effective and additional option for finger neurocutaneous defect reconstruction when use of the local and regional flaps is not feasible.

The reverse island flap pedicled with the dorsoulnar artery of the thumb for skin coverage of the thumb tip / 中华显微外科杂志

Objective To explore the operative methods and clinical effects of the reverse island flap pedi-cled with the dorsoulnar artery of the thumb for skin coverage of the thumb tip. Methods From February, 2013 to July, 2016, there were 11 cases of thumb tip defect distal to the superior nail fold who were treated with reverse dor-soulnar island flap, which was located on the dorsoulnar side of proximal thumb, and rotated with a 2 mm-wide pedi-cle at the dorsal arcade of the proximal nail fold. The skin over the rotated pedicle was sutured tensionless and the donor site was sutured directly. Postoperative follow-up was done termly. Results All 11 flaps survived eventually, and 9 cases were followed-up with a period of 3-38 months. Benefitting from the fair colored, well textured, plump but not bulky flap, the restored thumb had a satisfactory figure. The thumb also had good algesthesia and thalposis togeth-er with the flap. The thumb had a nearly normal ROM of interphalangeal joint and metacarpophalangeal joint, and opening angle of first web compared with the contralateral side. Conclusion The reverse island flap of dorsoulnar thumb, which is nourished with a constant vessel, is easily harvested and reliable. The flap can be used to repair the small skin defect of the thumb tip with a good result and few complication.

Innervated Digital Artery Perforator Propeller Flap for Reconstruction of Lateral Oblique Fingertip Defects.

PURPOSE: To report our experience with the use of a digital artery perforator propeller flap based on a constant distal perforator in the middle phalanx for resurfacing of lateral oblique fingertip amputations. METHODS: Twelve fingertips in 10 patients underwent reconstruction, with a mean follow-up of 8 months (range, 8-12 mo). The size of the flaps ranged from 2.5 × 1.5 cm to 3.0 × 2.0 cm. RESULTS: All flaps survived entirely and restored a rounded fingertip contour. Mean static 2-point discrimination was 5 mm (range, 4-6 mm). With the exception of 1 patient with an amputation at the distal interphalangeal joint, the distal interphalangeal joint was preserved in all patients and had 30° to 60° of motion at final follow-up. No patients complained of cold intolerance or residual joint contracture. No hooked nail deformity occurred in patients who had remaining nailbed. CONCLUSIONS: The digital artery perforator propeller flap is particularly suited to coverage of a lateral oblique fingertip defect, because only a 90° rotation is required when inset, and the bulk of the flap serves to restore the rounded contour of the fingertip. The skin over the entire dorsal surface of the middle phalanx can be elevated as a flap, providing adequate tissue to resurface the defect and restore a rounded contour to the fingertip. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Reconstruction of a soft tissue defect in the finger using the heterodigital neurocutaneous island flap.

BACKGROUND: This article describes reconstruction of a soft tissue defect in the finger using the heterodigital neurocutaneous island flap and reports the results of the use of the flap. METHODS: From February of 2008 to March of 2011, the neurocutaneous island flap was used in 12 patients with soft tissue defects in the middle phalanx or the proximal interphalangeal joint, or both. The injured fingers included 4 index, 3 middle, 3 ring and 2 little fingers. The donor fingers included 7 middle fingers and 5 ring fingers. The mean size of soft tissue defects and the flaps was 2.4 cm × 1.8 cm and 2.7 cm × 2.0 cm, respectively. The mean pedicle length was 2.8 cm. RESULTS: Full flap survival was achieved in 11 cases. Partial distal flap necrosis was noted in one case, which healed without surgical intervention. At a mean follow-up of 22 months, the mean static 2-point discrimination and Semmes-Weinstein monofilament scores on the flap were 8.3mm and 3.94, respectively. Based on the modified American Society for Surgery of the Hand guidelines for stratification of 2-point discrimination, 10 (83%) of 12 flaps achieved good results. According to the Michigan Hand Outcomes Questionnaire, 5 patients were strongly satisfied and 7 were satisfied with functional recovery of the reconstructed finger. CONCLUSIONS: The neurocutaneous island flap of the dorsal branch of the digital nerve is useful, reliable, and technically easy for reconstructing a defect in the adjacent fingers, especially when sensory reconstruction is needed.

Neurovascular Free Toe Pulp Flap Using Dorsal Digital Artery In Finger Reconstruction

Free neurovascular flap transfers have been widely used for restoration of discriminative sensibility and contour of the finger. The free neurovascular flaps from first web space of the foot is a good treatment option to achieve above two conditions. Fingertip reconstruction with a free toe pulp neurovascular flap, since it was described first in 1979, have been reported a lot. But in most cases. toe pulp flap used first dorsal metatarsal artery as a vascular pedicle. The authors, therefore, carried out four dissections on the cadavers to study first web space neurovascular anatomy for using the dorsal digital artery of the foot as a vascular pedicle. On the basis of the results of this cadaver dissection, we reconstructed posttraumatic soft tissue defect of the fingers with first and second toe pulp free flaps in nine patients from February 1999 to April 2000, and obtained adequate functional recovery as well as satisfactory aesthetic appearance. In our case, maximal flap was 2.5 x 2 cm in size, and the dorsal digital artery of the foot, subcutaneous vein and branch of the dorsal deep peroneal nerve were used as a neurovascular pedicle of the flap. All patients gradually recovered a discriminative sensibility, with static two-point discrimination test between 7 and 16mm and a moving two-point discrimination test between 6 and 13mm. The advantages of this free flap from toe(mainly second toe) are minimal donor site morbidity including arterial system, one-stage operation and shorter rehabilitation period. We consider that the free toe pulp flap using dorsal digital artery of the foot is a useful method for reconstruction of small finger soft tissue defect.