An ultra-thinned groin flap for reconstruction of complete digital ring avulsion injuries

Abstract

In complete digital ring avulsions, amputation is usually carried out when replantation of the avulsed tissue is not an option or has failed. The purpose of this study was to report our experience in treating Urbaniak Class III degloved fingers using an ultra-thinned pedicled groin flap. Sixteen patients from ages 11 to 26 years were included. In all cases, the flexor digitorum superficialis tendon, extensor apparatus and proximal interphalangeal joint were intact. Rehabilitation included immediate active mobilization, with flap division at day 21. At a mean follow-up of 15 months, all patients but one were satisfied with the appearance. Two had mild subjective cold intolerance. No flap failure was recorded. The mean total active motion was 183° and the mean QuickDASH score was 8.8/100. Patients recovered S1 sensibility according to the Mackinnon and Dellon classification. The ultra-thinned groin flap has proved to be a reliable technique for non-replantable ring avulsions. Level of evidence: IV

Delayed management of a ring finger injury by a thinned and tubed groin flap in a forward surgical unit

“…Regarding the high risk of infection, internal fixation of distal phalange was precluded, and a transdistal interphalangeal amputation was performed. Immediate soft-tissue reconstruction was achieved using the so-called ‘ willy flap ’ as described by Manoukov et al 1 (Figure 2). A pedicled groin flap was lifted with a long tube to facilitate digits and wrist motion and was immediately defatted for aesthetical and functional concerns.…”

“…The flap described by Manoukov et al 1 fulfils all the conditions for delayed reconstruction of the so called ‘ ring finger avulsion ’ in austere conditions, as complete skin degloving is equivalent to a complete amputation in all the commonly used ring finger classifications. First, it is a simple, reliable and replicable procedure adapted from the well-known groin flap described by McGregor 2.…”