[Modified reverse homodigital artery island flap for repair of fingertip defect]

Youmao Zheng, Fayun Zhang, Lizhi Wu, Shuqing Song, Bozhen Zheng, Shilin Gu
Chinese Journal of Reparative and Reconstructive Surgery 2009, 23 (7): 811-3

OBJECTIVE: To investigate the operative method and clinical efficacy of repairing fingertip defect with modified reverse homodigital artery island flap.

METHODS: From March 2000 to September 2006, 18 cases (24 fingers) of fingertip defect were treated, including 12 males and 6 females aged 18-53 years (mean 29 years). Defect was caused by crush injuries in 12 cases, by avulsion injury in 3 cases, by twist injury in 2 cases and by incised injury in 1 case. The time from injury to operation was 2-8 hours (mean 4 hours). The location were index fingers (3 fingers), middle fingers (4 fingers) and ring fingers (17 fingers). The defects of soft tissue were 1.9 cm x 1.7 cm to 2.4 cm x 1.9 cm in size, the reverse homodigital artery island flaps were from 2.0 cm x 1.5 cm to 2.5 cm x 2.0 cm in size. The donor site was repaired with dumped skin grafting (3 cases) and with skin grafting from medial area of planta pedis (15 cases).

RESULTS: Skin flaps and skin grafting of all the 24 fingers survived after operation. All incisions and donor sites healed by first intention. Sixteen patients (22 fingers) were followed up for 1-5 years (mean 3.2 years).The appearance and function of the flaps were all satisfactory. Two-point discriminations of flaps ranged from 4.5 mm to 6.3 mm. According to the total active movement/total passive movement assessment criteria, the results were excellent in 20 fingers and good in 2 fingers; and the excellent and good rate was 100%. The circumference of donor site was 2.0-3.5 mm shorter than that of normal side. The two-point discriminations of donor site was 7.8-10.5 mm.

CONCLUSION: Repairing defect of fingertip with modified reverse homodigital artery island flap can provide good texture and contour matching the recipient area, good function and little trauma at donor site.

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