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.

The Second Dorsal Metacarpal Artery Neurovascular Island Flap

1989 ◽  
Vol 14 (4) ◽  
pp. 434-440
Author(s):  
M. J. EARLEY
Keyword(s):  
Donor Site ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Island Flap ◽  
Arterial Supply ◽  
Flap Necrosis ◽  
Local Skin ◽  
Skin Defects ◽  
Dorsal Metacarpal Artery

Eleven patients have had second dorsal metacarpal sensate island flaps used to cover local skin defects in the hand. The arterial supply is reliable but if the flap is extended beyond the proximal interphalangeal joint, distal flap necrosis or donor site difficulties may occur. Possible applications for this flap are demonstrated and some untried variations to increase its range are suggested. Its main use appears to be in the release of first web contractures and for resurfacing radio-palmar and thumb defects.

Submental Flap for Soft Tissue Reconstruction following Radical Parotidectomy

2019 ◽  
Vol 160 (6) ◽  
pp. 1130-1132 ◽  
Author(s):  
Rodrigo Bayon ◽  
Andrew B. Davis
Keyword(s):  
Soft Tissue ◽  
Medical Center ◽  
Donor Site ◽  
Case Series ◽  
Island Flap ◽  
Hospital Length Of Stay ◽  
Soft Tissue Reconstruction ◽  
Submental Flap ◽  
Tissue Reconstruction ◽  
Submental Island Flap

This study analyzed our institution’s experience with a buried submental flap for soft tissue reconstruction following radical parotidectomy. A retrospective chart review was conducted of patients who had parotid malignancies requiring radical parotidectomy, who also underwent a buried submental flap reconstruction. Analysis included patient demographics and clinical, surgical, and outcome data. Three patients met criteria for this study who underwent a buried submental flap at a tertiary medical center between 2012 and 2016. All patients had oncologic surgery and reconstruction using a deepithelialized submental island flap, which was used to fill the radical parotidectomy surgical defect with no complications and good aesthetic results. Each patient received appropriate adjuvant therapy. This case series shows that the buried submental island flap is a versatile flap that is adequate bulk after radical parotidectomy. It also has no impact on hospital length of stay and provides excellent cosmetic outcomes with minimal donor site morbidity.

A Homodigital Reverse Pedicle Island Flap in Soft Tissue Reconstruction of the Finger and the Thumb

1994 ◽  
Vol 19 (2) ◽  
pp. 135-141 ◽  
Author(s):  
N. S. NIRANJAN ◽  
J. R. ARMSTRONG
Keyword(s):  
Soft Tissue ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Single Stage ◽  
Island Flap ◽  
Tissue Loss ◽  
Soft Tissue Reconstruction ◽  
Tissue Reconstruction

A single stage homodigital reverse pedicle island flap is described for the repair of volar or dorsal tissue loss on the finger or thumb. Donor site morbidity is minimal, and the length of the digit is preserved. Satisfactory function results in 25 patients are presented.

Homodigital artery flap reconstruction for fingertip amputation: a comparative study of the oblique triangular neurovascular advancement flap and the reverse digital artery island flap

2013 ◽  
Vol 40 (3) ◽  
pp. 291-297 ◽  
Author(s):  
S. Usami ◽  
S. Kawahara ◽  
Y. Yamaguchi ◽  
T. Hirase
Keyword(s):  
Range Of Motion ◽  
Advancement Flap ◽  
Island Flap ◽  
Digital Artery ◽  
Fingertip Amputation ◽  
Active Range Of Motion ◽  
Significant Difference ◽  
Sensory Recovery ◽  
Fingertip Reconstruction ◽  
Monofilament Test

This fingertip reconstruction study retrospectively compared sensory recovery and active range of motion outcomes in neurovascular island advancement and reverse digital artery island flaps. Seventeen oblique triangular flaps and 14 reverse digital artery island flaps were performed for nail bed level fingertip amputations (Ishikawa subzone II). There was no significant difference between the two procedures in the Semmes–Weinstein monofilament test and range of motion results. For static and moving two-point discrimination tests, however, those with a reverse digital artery island flap required a longer period for sensory recovery compared to those with an oblique triangular advancement flap. This trend equilibrated at 12 months after surgery showing no significant difference in both static and moving two-point discrimination tests between the procedures.

scholarly journals Fingertip Reconstruction with Subcutaneous Island Flap and Composite Graft: A Case Report

2020 ◽  
Vol 25 (4) ◽  
pp. 282-286
Author(s):  
Jinha Park ◽  
Jin Soo Kim ◽  
Sung Hoon Koh ◽  
Dong Chul Lee ◽  
Si Young Roh ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Composite Graft ◽  
Soft Tissue Defect ◽  
Distal Phalanx ◽  
Island Flap ◽  
Terminal Branch ◽  
Skin Defect ◽  
Secondary Intention ◽  
The Right ◽  
Fingertip Reconstruction

Reconstruction of amputated fingertips is extremely challenging when the amputee is very small and severely crushed. Moreover, there are not many options if distal phalanx is exposed due to defects of soft tissue. We report a case of successful fingertip reconstruction in a 10-month-old girl using a subcutaneous island flap with a composite graft. Her fingertip of the right little finger was amputated stuck by the air purifier. Some soft tissue was lost from the stump and the bone was exposed. There was a very small amputee, and soft tissue was extremely little inside. Replantation was not possible because of the soft tissue defect. The composite graft was inadequate due to the exposure of distal phalanx and defect of soft tissue. Soft tissue island flap based terminal branch of the digital artery was transposed to cover the distal phalanx. After then, the amputee was grafted over the flap. After debridement, most of the soft tissue survived and 0.2×0.2 cm of skin defect was found, which was healed through secondary intention.

scholarly journals Retrospective analysis of free temporoparietal fascial flap for defect reconstruction of the hand and the distal upper extremity

2020 ◽  
Author(s):  
Wibke Müller-Seubert ◽  
Raymund E. Horch ◽  
Vanessa Franziska Schmidt ◽  
Ingo Ludolph ◽  
Marweh Schmitz ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Soft Tissue ◽  
Upper Extremity ◽  
Reconstructive Surgery ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Soft Tissue Reconstruction ◽  
Flap Necrosis ◽  
Fascial Flap ◽  
Tissue Reconstruction

Abstract Introduction Soft tissue reconstruction of the hand and distal upper extremity is challenging to preserve the function of the hand as good as possible. Therefore, a thin flap has been shown to be useful. In this retrospective study, we aimed to show the use of the free temporoparietal fascial flap in soft tissue reconstruction of the hand and distal upper extremity. Methods We analysed the outcome of free temporoparietal fascial flaps that were used between the years 2007and 2016 at our institution. Major and minor complications, defect location and donor site morbidity were the main fields of interest. Results 14 patients received a free temporoparietal fascial flap for soft tissue reconstruction of the distal upper extremity. Minor complications were noted in three patients and major complications in two patients. Total flap necrosis occurred in one patient. Conclusion The free temporoparietal fascial flap is a useful tool in reconstructive surgery of the hand and the distal upper extremity with a low donor site morbidity and moderate rates of major and minor complications.

scholarly journals First dorsal metacarpal artery islanded flap: A useful flap for reconstruction of thumb pulp defects

2009 ◽  
Vol 42 (01) ◽  
pp. 032-035
Author(s):  
Chetan Satish ◽  
Sunit Nema
Keyword(s):  
Soft Tissue ◽  
Local Anesthesia ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Tissue Loss ◽  
Flap Necrosis ◽  
Secondary Procedure ◽  
Dorsal Metacarpal Artery ◽  
Soft Tissue Loss ◽  
First Dorsal Metacarpal Artery

ABSTRACTThumb pulp defects are commonly due to avulsion injuries. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. A very good option for coverage of these defects is the islanded first dorsal metacarpal artery flap. Our study was done over a period of 2 years and involved 9 consecutive cases of thumb pulp defects treated at our institution. The patients included 8 males and 1 female, ranging in age from 16 to 51 years old. The flap size ranged from 2 × 1.5 cm to 5 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under local anesthesia with tourniquet control. All the patients had good fine touch and average two-point discrimination of 6 mm, which was satisfactory. Our good results further reinforce the islanded first dorsal metacarpal artery flap as one the best flaps for sensate reconstruction of thumb pulp defects. It replaces the soft tissue loss at the thumb pulp with minimal donor site morbidity and with good return of thumb pulp sensation.

scholarly journals Soft Tissue Reconstruction around the Ankle with Sural Artery Flap

2018 ◽  
Vol 36 (3) ◽  
pp. 101-106
Author(s):  
Maruf Alam Chowdhury ◽  
Shafquat Hussain Khundkar ◽  
Md Ayub Ali ◽  
Md Obaidul Islam
Keyword(s):  
Soft Tissue ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Good Alternative ◽  
Soft Tissue Reconstruction ◽  
Flap Necrosis ◽  
Short Operative Time ◽  
Sural Flap ◽  
Number Of Patients ◽  
Sural Artery

Reconstruction for injuries around the ankle becomes a challenge due to limitation of available similar or near similar tissue. Tendons, bones and joints are frequently exposed after trauma because of the thinness of the subcutaneous tissue around the ankle. A durable flap with good texture, reliable vascularity, good arc of rotation and minimum donor site morbidity is always desired for coverage of such defect. Traditionally local flaps are used for resurfacing but their use is limited by their size and arc of rotation. This study was done in the dept. of Plastic Surgery, NITOR from Dec, 2012 to Feb, 2016. Total number of patients was 50 and their age varied from 7 years to 55 years. Among the 50 patients, 41 patients recovered uneventfully, 8 patients showed partial flap necrosis and complete flap necrosis in 1 patient. The distally based sural flap is a versatile and reliable flap for coverage of soft tissue defects around the ankle. Most of the cases were single stage procedure except extended reverse sural flap. The dissection is easy with short operative time and minimum morbidity. Thus the superficial sural artery flap can be used as a good alternative to microsurgical reconstruction.J Bangladesh Coll Phys Surg 2018; 36(3): 101-106

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.

Functional Outcomes of Antegrade Homodigital Neurovascular Island Flaps for Fingertip Amputation

2017 ◽  
Vol 22 (01) ◽  
pp. 39-45 ◽  
Author(s):  
Lin-Wing Lok ◽  
Wing-Leung Chan ◽  
Yan-Kit Lau
Keyword(s):  
Functional Outcomes ◽  
Flexion Contracture ◽  
Island Flap ◽  
Tissue Loss ◽  
Secondary Surgery ◽  
Work Related ◽  
Nail Deformity ◽  
Distal Interphalangeal ◽  
The Mean ◽  
Amputation Injury

Background: Fingertip amputations can be debilitating and challenging to treat, due to the need for both function and cosmesis. We studied the functional outcomes of patients receiving an antegrade homodigital neurovascular island flap for fingertip amputations. Methods: From 2004 to 2013, we performed 13 cases of antegrade homodigital neurovascular island flaps. Functional outcomes were studied. Four had Allen Zone II and nine had Zone III injuries. Seven were performed as secondary surgery. The mean followup period was 36 weeks. Results: All the flaps survived. Ten of 11 had less than or equal to 6 mm two-point discrimination. Five patients were noted to have mild flexion contracture at distal interphalangeal joints ranging from 5 to 10 degrees. There were three cases with nail deformity, three with fingertip hypersensitivity and four with cold intolerance. For patients injured on duty, the mean duration of sick leave taken was 18.5 weeks. Conclusions: With careful patient selection, the antegrade homodigital neurovascular island flap is a reliable means of restoring the function of the fingertip after amputation injury with significant tissue loss. Flap survival, sensibility and mobile adjacent joint can be expected, even when performed as a secondary surgery and for patients with work-related injuries.

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