Fingertip Reconstruction With Reverse Adipofascial Homodigital Flap

Karameşe, Mehtap; Akatekin, Ahmet; Abac, Malik; Koplay, Tuğba Gün; Tosun, Zekeriya

doi:10.1097/sap.0000000000000137

Cited by 14 publications

(10 citation statements)

References 9 publications

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“…Besides, two-point discrimination measurements were found to be similar to the outcomes of some studies. [18,19] Another advantage of nerve repair is to prevent neuroma formation on the nerve terminal to be exposed and then minimize any pain, which will decrease the quality of life. When compared to other fingertip reconstructions (i.e., Thenar or cross-finger flap), reposition flap procedures can be used in medical practice in that it is a single-stage method without disadvantages of other methods, such as joint stiffness, restricted range of motion of the joint, and requirement of more than one session of surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Sır¹,

Aksoy²,

Aksoy³

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures. METHODS: Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2 nd , 3 rd , and 4 th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9-23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes-Weinstein monofilament test, and cold intolerance test for the development of neuroma on the donor site. RESULTS: In 5 patients, replantation procedure failed. In such failed patients, after the removal of necrotic tissues, the stump was either repaired or reconstruction with a flap was applied. Wound dehiscence was observed at the lateral sides of the flaps in 2 patients who underwent reposition procedures. CONCLUSION: Reposition flap repair can be a good cost-effective alternative to other fingertip repair procedures in appropriately selected patients who are not amenable to microsurgery. It preserves the length and sensory functions of fingertips and enables patients to return to their daily life as soon as possible.

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Section: Discussionmentioning

confidence: 99%

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Sır¹,

Aksoy²,

Aksoy³

2018

Ulus Travma Acil Cerrahi Derg

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“…In spite of not including the nerve, mean static 2-PD was 4.5 mm (range-3–5.5 mm). In a study by Karamese et al .,[ 4 ] adipofacial RHAF was done with skin graft and nerve coaptation to contralateral nerve ending, mean static 2-PD was 4.86 mm (range-3–6 mm). Surprisingly, in spite of not doing a nerve coaptation, we had similar results with sensory recovery.…”

Section: Discussionmentioning

confidence: 99%

Why borrow from Peter when Paul can afford it? Reverse homodigital artery flap for fingertip reconstruction

Sundaramurthy

Mahipathy

2017

Indian J Plast Surg

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Background:Fingertip injuries that are complicated by pulp loss, bone or tendon exposure will need a flap cover. Cross finger flap is commonly used to cover such defects. However, patients are apprehensive about injuring the uninjured finger as a donor site. Reverse homodigital artery flap (RHAF) can provide reliable vascularised cover to such defects.Aims:This study aims to assess the functional and aesthetic outcomes along with the patient satisfaction of RHAFs done for fingertip defects.Materials and Methods:RHAFs done in 18 patients operated between August 2015 and October 2016 were retrospectively analysed on flap survival, sensory recovery, range of movements, hypersensitivity, cold intolerance, flexion contracture and donor site morbidity.Results:Seventeen of the 18 flaps done survived completely. One flap had partial necrosis of 3 mm that healed conservatively. Middle finger of the right hand was the most commonly injured finger. Touch, pain and pressure sensations recovered in 8–12 weeks. Two-point discrimination was 4.5 mm at 6 months. The deficit of 5° s was present at distal interphalangeal joint during active flexion at 6 months. Cold intolerance and flexion contracture were not seen and 2 instances of hypersensitivity at 2 months got cured conservatively after 4 months. Overall satisfaction of patients was 8/10.Conclusion:RHAF provides single staged well-vascularised cover for fingertip injuries with good sensory recovery without damaging the adjacent uninjured finger. Hence, it can be a reliable flap for fingertip reconstruction in selected cases.

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“…Many options have been described to repair these defects and aim to preserve the function and maintain the native color and texture. (Akdag, Yildiran, Sutcu, & Karamese, ; Karamese, Akatekin, Abac, Koplay, & Tosun, ; Liu, Wang, Li, & Du, ; Rehim, Kowalski, & Chung, )…”

Section: Introductionmentioning

confidence: 99%

The V‐Y advancement flap based on the dorsal carpal perforators for dorsal metacarpal reconstruction: Anatomical and clinical study

Chen

Zhang

et al. 2020

Clinical Anatomy

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Introduction: Soft-tissue defects on the dorsal hand accompanied by exposed bone and tendon remain a challenge for plastic surgeons. The purpose of this study was to observe the morphological characteristics of the dorsal carpal perforators in the wrist and to design a V-Y advancement flap based on the dorsal carpal perforators. Materials and Methods: Thirty cadaveric hand specimens were dissected to observe the origin, course, branches, and anastomoses of the dorsal carpal perforators, and a V-Y advancement flap was designed based on these perforators. Clinically, nine cases of dorsal hand defects were reconstructed with this flap. Results: The dorsal carpal vascular network was formed by vascular anastomoses along the dorsal carpal branch of the radial artery, dorsal carpal branch of the anterior interosseous artery, ascending branch of the dorsal carpal perforator from the deep palmar arch, direct branch of the radial artery, dorsal carpal branch of the ulnar artery, posterior interosseous artery, and deep palmar branch of the ulnar artery; this network could be divided into a deep vascular network and superficial vascular network according to the anatomical plane. Among the perforators, the third and fourth perforators that pierce out bilaterally from the tendon of the extensor digitorium had a consistent occurrence rate (100%) with an outer diameter of 0.7 ± 0.3 mm and 0.6 ± 0.2 mm, respectively, and thus could be chosen as the vascular pedicle. In clinical applications, all flaps survived completely with excellent color and texture, a satisfactory appearance, and normal movement of the wrist joint. Conclusions: A V-Y advancement flap based on the dorsal carpal perforators can become a useful choice for the repair of dorsal metacarpal defects caused by trauma or dorsal metacarpal arterial flaps.

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Fingertip Reconstruction With Reverse Adipofascial Homodigital Flap

Cited by 14 publications

References 9 publications

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Why borrow from Peter when Paul can afford it? Reverse homodigital artery flap for fingertip reconstruction

The V‐Y advancement flap based on the dorsal carpal perforators for dorsal metacarpal reconstruction: Anatomical and clinical study

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