Commentary on Zhang et al. Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

This article describes the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of the volar defects at the proximal interphalangeal joint. The flap was based on the first dorsal branch of the proper digital artery. From January 2007 to March 2009, 14 digits in 14 patients (10 males and 4 females) were treated. There were 5 index, 6 middle, 2 ring, and 1 little finger. All patients underwent surgery 2–9 hours (mean 5 hours) after injury. Soft tissue defects ranged in size from 1.2 × 1.7 cm to 2.1 × 2.3 cm (mean 1.7 × 2 cm). Flap size ranged from 1.5 × 1.7 cm to 2.4 × 2.7 cm (mean 2 × 2.4 cm). Mean pedicle length was 1.1 cm (range 0.8–1.4 cm). All flaps completely survived. At final follow-up from 24–29 months (mean 26 months), mean active motion arcs of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 84° (range 75–91°), 86° (range 65–100°) and 54° (range 32–80°), respectively. Our technique is useful and reliable for coverage of a palmar defect over the proximal interphalangeal joint.

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Irreducible Compound Dorsal Dislocations of the Proximal Interphalangeal Joint of the Finger

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90011-2 ◽

1986 ◽

Vol 11 (1) ◽

pp. 49-50

Author(s):

INGER KJELDAL

Keyword(s):

Soft Tissue ◽

Open Reduction ◽

Proximal Phalanx ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Probable Mechanism ◽

Hand Injuries ◽

Tissue Structures

Three cases of compound irreducible dorsal dislocation of the proximal interphalangeal joint of the finger are reported. The probable mechanism is discussed. The findings warrant the description “volar capsular boutonnière” as the condyles of the proximal phalanx buttonhole, through the volar structures. Open reduction combined with debridement, is the treatment for such compound irreducible dorsal dislocations. Dislocation of the proximal interphalangeal joints of the fingers are common and can usually be reduced by simple traction. Occasionally reduction by closed methods is unsuccessful because of interposition of volar or dorsal soft tissue structures (Lamb 1981). This study reports three cases of compound dorsal dislocation of the proximal interphalangeal joint with volar soft tissue interposition. Such lesions are sparsely mentioned in text books on fractures and hand injuries and hitherto only a few cases have been published (Lamb 1981, Bunnell 1956).

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The Lateral Proximal Phalanx Flap for Contractures and Soft Tissue Defects in the Proximal Interphalangeal Joint

Hand ◽

10.1177/1558944716646781 ◽

2016 ◽

Vol 12 (1) ◽

pp. 91-97 ◽

Cited By ~ 3

Author(s):

Aldo G. Beltrán ◽

Camilo J. Romero

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Proximal Phalanx ◽

Proximal Interphalangeal Joint ◽

Soft Tissue Defects ◽

Transposition Flap ◽

Skin Defects ◽

Pip Joint ◽

Safe Technique ◽

Tissue Defects

Background: The management of contractures and soft tissue defects in the proximal interphalangeal (PIP) finger joint remains a challenge. We report a transposition flap from the lateral skin of the proximal phalanx that is based on perforating branches of the digital arteries and can be used safely for both palmar and dorsal cover defects. Methods: We first completed an anatomic study, dissecting 20 fingers in fresh cadavers with arterial injections and made the new flap in patients with dorsal or palmar defects in PIP joints. Results: In cadavers, we can reveal 4 constant branches from each digital artery in the proximal phalanx, with the more distal just in the PIP joint constituting the flap pedicle. Between February 2010 and February 2015, we designed 33 flaps in 29 patients, 7 for dorsal and 26 for palmar defects, with no instances of flap necrosis and 4 distal epidermolysis. The patients were between 4 and 69 years with no major complications, and all of the skin defects in the PIP joint were resolved satisfactorily without any relevant sequelae at the donor site. Conclusions: This flap procedure is an easy, reliable, versatile, and safe technique, and could be an important tool for the management of difficult skin defects and contractures at the PIP joint level.

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Repair of Dorsal Defects Over the Middle Phalanx and Proximal Interphalangeal Joint With a Transposition Flap From the Dorsum of the Proximal Phalanx

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2011.02.023 ◽

2011 ◽

Vol 36 (5) ◽

pp. 864-869 ◽

Cited By ~ 5

Author(s):

Yagao Feng ◽

Ming Hu ◽

Houjun Yan ◽

Xiangning Zhang ◽

Zhongsheng Tao ◽

...

Keyword(s):

Proximal Phalanx ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Middle Phalanx ◽

Transposition Flap

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ON-TOP PLASTY USING A FREE METACARPAL HEAD GRAFT FOR LENGTHENING OF PROXIMAL PHALANX IN SYMBRACHYDACTYLY — A CASE REPORT

Hand Surgery ◽

10.1142/s0218810413720192 ◽

2013 ◽

Vol 18 (02) ◽

pp. 273-275 ◽

Cited By ~ 1

Author(s):

Kousuke Iba ◽

Takuro Wada ◽

Toshihiko Yamashita

Keyword(s):

Case Report ◽

Soft Tissue ◽

Bone Growth ◽

Proximal Phalanx ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Soft Tissue Envelope ◽

Metacarpal Head ◽

Little Finger

A three-year old patient with symbrachydactyly (didactyly type) presented with a little finger that was too short to allow pinching and consisting of a floppy soft-tissue envelope with hypoplastic phalanges, although the thumb was functional. As the proximal phalanx was too small to permit distraction lengthening or conventional bone grafting, on-top plasty using a 4th metacarpal graft with a cartilage head was undertaken for lengthening the proximal phalanx of the little finger for pinch reconstruction. At ten weeks after surgery, the patient achieved satisfactory pinch function due to the lengthened and bone-stabilised postoperative digit and reconstruction of functional proximal interphalangeal joint. In addition, the grafted metacarpal demonstrated satisfactory bone growth throughout the six-year follow-up period.

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