Bilateral Side Finger Transposition Flaps in the Treatment of Chronic Postburn Flexion Contractures of the Fingers

Abstract

The authors present a surgical method of releasing postburn flexion contracture of the finger by two separate transverse incisions and covering the skin defects by transposing two random-pattern flaps from both sides of the finger. One of the proximally based flaps was transposed from one side of the proximal phalanx and the other flap was transposed from the opposite side of the middle phalanx. Because the flaps were raised from different sides of different phalanxes, the donor sites were closed primarily. A total of 37 fingers (14 hands, 11 patients) were treated with this method. The patients were all men aged 20 to 24 years old. The mean follow-up period was 9 months. The lack of extension of the proximal interphalangeal joints of the fingers was improved by approximately 45 deg using the described method. The authors conclude that this method can be used effectively in the treatment of mild to moderate postburn flexion contractures of the fingers.

The use of reverse-flow dorsal metacarpal artery flaps after postburn metacarpophalangeal joint flexion contracture release

“…Furthermore, skin grafting is not suitable for coverage since important structures such as tendons, nerves and vessels are exposed. Soft-tissue defects in the metacarpophalangeal joint after a contracture release can be covered with many local and distant flaps including cross-finger flap, side finger flap, palmar transposition flaps and their modifications [4,5,13,14]. But these methods have many disadvantages including sacrificing dorsal finger tissue, long time immobilization and failure to correct the deformity.…”

“…Contractures often require wide release and radical excision with reconstruction using well vascularized, supple, durable tissue that will not contract following the reconstruction. Extensive literature is available for local and regional flaps that may be used for these defects [2][3][4][5].…”

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

“…Total skin grafts can tend to contract, and thus could not be the best choice for tendon or neurovascular bundle exposition. 1,5 For Dupuytren disease, some surgeons use the McCash technique waiting for secondary intention closures; however, this approach requires a long splinting time in extension. We have found descriptions of rotation flaps, homodigital and heterodigital flaps, and combinations of lateral transposition flaps taken from the proximal and middle phalanxes that have been used to achieve the complete closure of defects in the PIP joint.…”

“…We have found descriptions of rotation flaps, homodigital and heterodigital flaps, and combinations of lateral transposition flaps taken from the proximal and middle phalanxes that have been used to achieve the complete closure of defects in the PIP joint. 1,7 Such approaches, although successful, are usually complex, require multiple surgeries, and demand large incisions in the injured finger and/or healthy areas in other fingers, increasing regional morbidity. The lateral regions of fingers are very rich in arterial anastomosis 6 ; they are usually protected from burns and able to retain healthy skin and subcutaneous tissues.…”

“…Furthermore, the relative skin excess in this area allows for primary closure if used as a donor site. 1,5,7 With this in mind, we have designed a new surgical technique calling for a flap to be taken from the lateral side of the proximal phalanx with a distal pivot point in the PIP joint. This approach can be easily modified for either the dorsum or the palm to cover any defects in this location within a single surgery without harming the adjacent fingers while still achieving a reliable vascular pedicle and minimal sequelae in the donor area.…”