[Short-term effectiveness of reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction for repairing fingertip defects]

Zhongcun Lu, Jinliang Yu, Weihua Peng, Mingming Wei, Binglei Wei
Chinese Journal of Reparative and Reconstructive Surgery 2011, 25 (9): 1033-5

OBJECTIVE: To investigate the method and effectiveness of repairing fingertip defects with reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction.

METHODS: Between December 2008 and March 2010, 32 patients (40 fingers) with fingertip defects were treated. There were 20 males (23 fingers) and 12 females (17 fingers), aged from 20 to 62 years (mean, 42 years). The time between injury and admission was from 1 to 8 hours. The injured fingers included thumb (2 cases), index finger (6 cases), index finger and middle finger (3 cases), middle finger (7 cases), middle finger and ring finger (3 cases), ring finger (8 cases), ring finger and little finger (2 cases), and little finger (1 case). The defect area ranged from 1.2 cm x 1.0 cm to 2.2 cm x 1.8 cm, and the flap area ranged from 1.5 cm x 1.0 cm to 2.5 cm x 2.0 cm. The fingertip defects were repaired by the reverse island flaps pedicled with terminal dorsal branch of digital artery and branch of digital nerve, and the branch of digital nerve was anastomosed with stump of proper digital nerve. The donor sites were repaired with free skin grafts.

RESULTS: Blisters occurred in 6 cases (9 fingers) and partial necrosis of the flaps in 2 cases (2 fingers), which were cured after symptomatic treatment. The other flaps and skin grafts survived and the wounds healed by first intention. Thirty cases (38 fingers) were followed up 6 months postoperatively. The shape, contour of the reconstructed fingertip, and motivation of the fingers were satisfactory. The superficial sensation and deep pain sensation recovered after 6 months of operation. The two-point discrimination was 4-6 mm in 24 fingers, 7-10 mm in 13 fingers, and none in 1 finger. According to the functional assessment criteria of upper limb formulated by the Hand Surgery Branch of Chinese Medical Association, S3 was achieved in 1 finger, S3+ in 13 fingers, and S4 in 24 fingers.

CONCLUSION: It is simple and safe to harvest the reverse island flap pedicled with terminal dorsal branch of digital artery with sense reconstruction; at the same time, the blood supply of the flap is reliable and its sense can be reconstructed. It is one of effective methods for repairing fingertip defects.

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