Versatility of the Homodigital Triangular Neurovascular Island Flap in Fingertip Reconstruction

1995 ◽  
Vol 20 (6) ◽  
pp. 824-829 ◽  
Author(s):  
M. LANZETTA ◽  
B. MASTROPASQUA ◽  
A. CHOLLET ◽  
N. BRISEBOIS
Keyword(s):  
Functional Recovery ◽  
Flexion Contracture ◽  
Island Flap ◽  
Cold Intolerance ◽  
Pip Joint ◽  
Fingertip Reconstruction

This paper reports 25 cases of a versatile homodigital triangular neurovascular island flap for fingertip reconstruction. This flap was used to reconstruct traumatic oblique palmar amputations, with loss of fingertip pulp requiring advancement of not more than 2 cm. Good results were obtained in terms of fingertip contour and padding, sensibility, and functional recovery. The tendency for flexion contracture at the PIP joint was prevented by using a dynamic extension splint at night. Cold intolerance must be expected, especially in cold countries.

A Neurovascular Island Flap for Volar-Oblique Fingertip Amputations

1996 ◽  
Vol 21 (1) ◽  
pp. 94-98 ◽  
Author(s):  
T-M TSAI ◽  
JC YUEN
Keyword(s):  
Range Of Motion ◽  
Surgical Outcome ◽  
Reliable Method ◽  
Island Flap ◽  
Cold Intolerance ◽  
Pip Joint ◽  
Better Than

A neurovascular island flap has been developed to reconstruct volar-oblique fingertip amputations. This study analyzes the data collected on 16 patients who were treated with this flap and had at least 2 years follow-up. The average active/passive range of motion was 54/55° at the DIP joint, 96/98° at the PIP joint, and 83/83° at the MP joint. Twelve out of 16 flaps (75%) had two-point discrimination better than 10 ram. Moderate and severe problems included cold intolerance (six patients), hypersensitivity (three patients), stiffness (three patients), and numbness (two patients). Out of the 16 patients treated with this technique, 14 were satisfied with their surgical outcome. In experienced hands, this technique is a safe and reliable method with which to reconstruct volar-oblique fingertip amputations.

Flap Related Complications Requiring Secondary Surgery in a Series of 851 Local Flaps Used for Fingertip Reconstruction

2019 ◽  
Vol 24 (01) ◽  
pp. 24-29 ◽  
Author(s):  
T. Karjalainen ◽  
S.J. Sebastin ◽  
K.G. Chee ◽  
Y.P. Peng ◽  
A.K.S. Chong
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Advancement Flap ◽  
Flexion Contracture ◽  
Island Flap ◽  
Local Flaps ◽  
Flap Necrosis ◽  
Secondary Surgery ◽  
Partial Necrosis ◽  
Fingertip Reconstruction

Background: Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues. Methods: 851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis. Results: 31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis. Conclusions: Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.

scholarly journals Reconstruction of Distal Phalangeal Injuries with Homodigital Island Flap: a Case Report

1970 ◽  
Vol 1 (4) ◽  
Author(s):  
Parintosa Atmodiwirjo ◽  
Sachraswaty Laidding
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Island Flap ◽  
Palmar Arch ◽  
Cold Intolerance ◽  
Recipient Site ◽  
Fingertip Reconstruction

Background: Reconstruction of distal phalangeal defects with exposure of bone, tendon, or joint can be a difficult reconstructive problem, particularly since immediate coverage is of paramount importance for preserving function. The objectives of distal phalangeal defect or fingertip reconstruction included preservation of functional length and sensibility, prevention of symptomatic neuromas, acceptable donor site morbidity, the absence of cold intolerance, mineralization of aesthetic deformity, and quick return to occupational activities.Patients and Method: A review of one case, 26 years old male with phalangeal defect at tip to radial site of 3th finger of right hand, with tendon and bone exposed. After adequate debridement, shape and size of the defect are measured, the flap designed at the ulnar site of the same finger and the vascular of the flap is marked to palmar arch. Lazy “S” incision performed, donor flap is elevated with pedicle and transferred to the recipient site. Donor site was covered up with skin graft. Result: After follow up the homo digital island flap was healed nicely and the skin graft take was 100%, length is less diminish, sensibility conformed with two-point description, joint flexibility is good.Summary: Homodigital island flap is a useful safe option for fingertip or distal phalangeal reconstruction because it offers multiple advantages in comparison with advancement, regional, and free flaps, with an almost negligible donor site defect and can be done in a 1-stage procedure.

scholarly journals Why borrow from Peter when Paul can afford it? Reverse homodigital artery flap for fingertip reconstruction

2017 ◽  
Vol 50 (02) ◽  
pp. 187-192
Author(s):  
Narayanamurthy Sundaramurthy ◽  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj
Keyword(s):  
Donor Site ◽  
Middle Finger ◽  
Donor Site Morbidity ◽  
Flexion Contracture ◽  
Cold Intolerance ◽  
Active Flexion ◽  
Sensory Recovery ◽  
The Right ◽  
Flap Cover ◽  
Fingertip Reconstruction

ABSTRACT Background: Fingertip injuries that are complicated by pulp loss, bone or tendon exposure will need a flap cover. Cross finger flap is commonly used to cover such defects. However, patients are apprehensive about injuring the uninjured finger as a donor site. Reverse homodigital artery flap (RHAF) can provide reliable vascularised cover to such defects. Aims: This study aims to assess the functional and aesthetic outcomes along with the patient satisfaction of RHAFs done for fingertip defects. Materials and Methods: RHAFs done in 18 patients operated between August 2015 and October 2016 were retrospectively analysed on flap survival, sensory recovery, range of movements, hypersensitivity, cold intolerance, flexion contracture and donor site morbidity. Results: Seventeen of the 18 flaps done survived completely. One flap had partial necrosis of 3 mm that healed conservatively. Middle finger of the right hand was the most commonly injured finger. Touch, pain and pressure sensations recovered in 8–12 weeks. Two-point discrimination was 4.5 mm at 6 months. The deficit of 5° s was present at distal interphalangeal joint during active flexion at 6 months. Cold intolerance and flexion contracture were not seen and 2 instances of hypersensitivity at 2 months got cured conservatively after 4 months. Overall satisfaction of patients was 8/10. Conclusion: RHAF provides single staged well-vascularised cover for fingertip injuries with good sensory recovery without damaging the adjacent uninjured finger. Hence, it can be a reliable flap for fingertip reconstruction in selected cases.

Cleland’s ligaments and Dupuytren’s disease

2013 ◽  
Vol 39 (5) ◽  
pp. 477-481 ◽  
Author(s):  
D. J. Shewring ◽  
U. Rethnam
Keyword(s):  
Histological Analysis ◽  
Residual Disease ◽  
Flexion Contracture ◽  
Joint Contracture ◽  
Dupuytren’S Disease ◽  
Histological Findings ◽  
Dupuytren's Disease ◽  
Pip Joint ◽  
Joint Flexion ◽  
Neurovascular Bundles

The aim of this study was to investigate whether Cleland’s ligaments are affected by Dupuytren’s disease and assess their contribution to the flexion contracture of the proximal interphalangeal (PIP) joint. Twenty patients with Dupuytren’s disease undergoing fasciectomy for a PIP joint contracture > 40° (mean 61°, range 45°–100°) were included. After excision of all other identifiable digital disease, Cleland’s ligaments were assessed. If they appeared to be macroscopically affected by Dupuytren’s disease they were excised, sent for histological analysis, and any further improvement of PIP joint contracture was recorded. There were 14 males and six females with a mean age of 62 (range 40–79) years. Excision of Cleland’s ligaments resulted in a mean further correction of 7° (range 0°–15°). Histological analysis indicated that Cleland’s ligament was clearly involved with Dupuytren’s disease in 12 patients, indicating that Cleland’s ligaments can be affected by Dupuytren’s disease. In the remaining specimens the histological findings were equivocal. As these structures are situated dorsal to the neurovascular bundles, a specific dissection has to be undertaken to identify them. Excision of Cleland’s ligaments at digital fasciectomy further avoids leaving residual disease and may yield a worthwhile further correction of PIP joint flexion contracture.

Reverse Midpalmar Island Flap Transfer for Fingertip Reconstruction

2008 ◽  
Vol 25 (03) ◽  
pp. 171-179 ◽  
Author(s):  
Shohei Omokawa ◽  
Ryotaro Fujitani ◽  
Yoshihiro Dohi ◽  
Yasuhito Tanaka ◽  
Hiroshi Yajima
Keyword(s):  
Island Flap ◽  
Flap Transfer ◽  
Fingertip Reconstruction

Anterior Tenoarthrolysis for Severe Flexion Contracture of the Fingers (The “Tata” Operation): A Review of 50 Cases

2007 ◽  
Vol 32 (2) ◽  
pp. 224-229 ◽  
Author(s):  
P. LOREA ◽  
J. MEDINA HENRIQUEZ ◽  
R. NAVARRO ◽  
P. LEGAILLARD ◽  
G. FOUCHER
Keyword(s):  
Flexion Contracture ◽  
Salvage Procedure ◽  
Extension Deficit ◽  
Salvage Operation ◽  
Active Range Of Motion ◽  
Pip Joint ◽  
Distal Interphalangeal ◽  
Joint Flexion ◽  
The Mean

The “hook finger”, with both proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint flexion contractures, often after multiple previous operations, is difficult to treat. This paper reports the results of 50 fingers in 49 patients in which the TATA (Téno-Arthrolyse Totale Antérieure) salvage procedure, described by Saffar in 1978, was carried out. Thirty-seven of 50 (74%) of these fingers had had at least one previous operation, most on the flexor apparatus. The mean PIP and DIP extension deficit pre-operatively was 133° with a mean PIP lag of extension of 83°. With a mean follow-up of 7.8 years, 45 fingers were improved, five were not and none was worsened. The mean PIP and DIP extension deficit postoperatively was 47°, with a mean PIP lack of extension of 31°. The overall gain in extension deficit of both joints was 86° and of the PIP was 52°. One PIP joint developed septic arthritis immediately after surgery. The benefit of this salvage operation is mainly in the change of the active range of motion to a more functional arc.

Arterialized Venous Dorsal Digital Island Flap for Fingertip Reconstruction

1998 ◽  
Vol 102 (7) ◽  
pp. 2368-2372 ◽  
Author(s):  
Aycan Kayıkçıoğlu ◽  
Mustafa Akyürek ◽  
Tunç Safak ◽  
Ömer Özkan ◽  
Abdullah Keçik
Keyword(s):  
Island Flap ◽  
Fingertip Reconstruction

scholarly journals Finger shortening for Dupuytren’s disease-induced severe PIP joint flexion contracture of the little finger: A report of two cases

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 11
Author(s):  
Yoko Ito ◽  
Kiyohito Naito ◽  
Nana Nagura ◽  
Yoichi Sugiyama ◽  
Hiroyuki Obata ◽  
...  
Keyword(s):  
Daily Living ◽  
Treatment Method ◽  
Flexion Contracture ◽  
Dupuytren’S Disease ◽  
High Patient Satisfaction ◽  
Dupuytren's Disease ◽  
Extended Position ◽  
Pip Joint ◽  
Joint Flexion ◽  
Little Finger

When severe proximal interphalangeal (PIP) joint flexion contracture is induced in the little finger by Dupuytren’s disease, it interferes with activities of daily living. To extend the little finger, open fasciectomy is selected as a general treatment method. However, postoperative complications have been frequently reported. To solve these problems, finger shortening was undertaken. In this study, we treated two cases of Dupuytren’s disease manifesting severe PIP joint flexion contracture of the little finger with finger shortening by proximodistal interphalangeal (PDIP) fusion in which the middle phalanx is resected and the residual distal and proximal phalanges are fused. For flexion contracture of the MP joint, a percutaneous aponeurotomy using an 18G needle was performed to obtain the extended position of the MP joint. Favorable outcomes with high patient satisfaction, including esthetic aspects of retaining the finger with the nail without complication, were achieved. We report this challenging treatment and its discussion.

Innervated Reverse Dorsal Digital Island Flap for Fingertip Reconstruction

2006 ◽  
Vol 31 (7) ◽  
pp. 1094-1099 ◽  
Author(s):  
Meisei Takeishi ◽  
Akihiko Shinoda ◽  
Atsuki Sugiyama ◽  
Keito Ui
Keyword(s):  
Island Flap ◽  
Fingertip Reconstruction
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