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Purpose: This study aimed to describe the reverse digital artery cross-finger flap (RDAC flap) in the treatment of failed finger replantation. Methods: This study retrospectively reviewed the records of patients who underwent modified RDAC flap reconstructions for failed finger replantation and assessed their outcomes. Of the patients who underwent soft tissue reconstructions for finger injuries between March 2011 and February 2015, we enrolled 11 patients in whom RDAC flap reconstruction procedures were performed to treat the failed replantations. Results: The flaps survived in all cases, with a mean static, two-point discrimination value of 5.3 mm (range, 4–7 mm) in the healed flaps. The sizes of the flaps ranged from 2 × 1 cm2 to 2.3 × 1.5 cm2. Conclusion: The RDAC flap was introduced by Lai et al., and it is a mixed form with the advantages of both cross-finger flap and heterodigital island flap. Our results suggest that it could provide reliable coverage of the sensate soft tissue of fingers with failed replantation.

Purpose: Fingertip replantation is a challenging and technically demanding procedure. A variety of venous drainage techniques have been attempted for successful fingertip replantation. We present a new venous drainage technique, known as serial multifocal incision for fingertip replantation. Methods: Between 2006 and 2014, we performed 94 fingertip replantations without vein anastomosis. Eighty of the patients were male, and 14 were female, with an overall mean age of 42 years (range: 8-67 years). All patients suffered amputations distal to the distal phalanx joint (Ishikawa subzone I, II, or III). We performed only artery anastomosis. To relieve venous congestion, we incised the fingertip 2-3 mm using a number 11 scalpel blade and allowed the vein to drain naturally. We made small serial incisions every 2-3 days for 1 week. Results: The overall success rate for this procedure was 90%, with 85 surviving digits. Two patients with partial necrosis and nine patients with complete loss needed a second operation. Two patients received blood transfusions with an average of 1.5 units, but both had an accompanying injury at another site. No one complained of nail deformity or wound infection. Conclusions: Various external bleeding techniques have been reported to yield good results. The serial stab incision venous drainage technique is a modified fish-mouth external bleeding technique that overcomes the disadvantages of published methods. This technique is simple, allows for easy control of venous drainage, and reduces the need for blood transfusions compared to other venous drainage techniques that cause large amounts of bleeding. We propose a new method, the serial stab incision venous drainage technique, which is effective and associated with high rates of survival.

The os subtibiale is a rare accessory bone, which should be distinguished from fracture of the medial malleolus because misinterpretation leads to the unnecessary surgery and immobilization. Herein, we report 3 cases of a symptomatic os subtibiale in preadolescent athlete with a review of the relevant literature.