Postoperative Voluminal Flap Reduction After Fingertip Reconstruction Using the Reverse Digital Artery Island Flap

Usami, Satoshi; Kodaira, Satoshi; Homma, Tsutomu; Okazaki, Mutsumi

doi:10.1142/s0218810415500197

Cited by 3 publications

(7 citation statements)

References 15 publications

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“…Flap area was measured as the multiplication of the major axis by the minor axes for convenient comparison as most RDAIF were designed in a circle or ellipse. 8,12 Several outcomes were measured by the hand therapist during the final follow-up, including postoperative joint movement, the active arc of the distal and proximal interphalangeal (DIP and PIP) joints, extension loss of the PIP joint, flexion arc of the metacarpophalangeal (MP) joint, total active motion (TAM = the total arc of the DIP + PIP + flexion arc of the MP joint), and %TAM (the percentage rate of TAM of the affected vs. contralateral side). Flap sensation was evaluated by static and moving 2-point discrimination (s2PD and m2PD), and patients were questioned for numbness, Tinel's sign, and cold intolerance.…”

Section: Methodsmentioning

confidence: 99%

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Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap

Usami¹,

Kawahara²,

Inami³

et al. 2022

Hand (New York, N,Y.)

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Background: This study aimed to compare the outcomes of reverse digital artery island flap (RDAIF) in primary and secondary reconstruction after failed replantation or composite graft method. Methods: This study retrospectively analyzed 42 patients that underwent RDAIF (18 primary and 24 secondary). Preoperative details (demographics, injury details, and waiting days) and postoperative outcomes (active arc of proximal interphalangeal [PIP] and distal interphalangeal (DIP) joints, extension loss of PIP, flexion arc of metacarpophalangeal joint, total active motion, flap sensation, the presence of numbness, Tinel’s sign and cold intolerance) were evaluated. Quick Disabilities of the Arm, Shoulder, and Hand score (Quick-DASH) and patient satisfaction were also statistically compared between the 2 groups. Results: There was no significant difference in patient demographics between the 2 groups in sex, age, smoking and diabetic history, affected hand and finger, injury type and level, and flap area. The only difference was in waiting days. Similar sensory recovery and patient satisfaction were found in both groups. Range of motion in the DIP and PIP joints, extension loss of PIP, total active motion, and Quick-DASH were superior in the primary coverage group. Increasing age, subzone III injury, and secondary reconstruction were found to be the factors that adversely affected the postoperative range of motion. Conclusions: Secondary reconstruction was more likely to result in joint contracture. In the event of a damaged fingertip amputation in older patients, primary flap reconstruction should be considered as the initial treatment of choice, with regard to the ultimate range of motion.

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Section: Methodsmentioning

confidence: 99%

“…Flap area was measured as the multiplication of the major axis by the minor axes for convenient comparison as most RDAIF were designed in a circle or ellipse. 8,12…”

Section: Methodsmentioning

confidence: 99%

Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap

Usami¹,

Kawahara²,

Inami³

et al. 2022

Hand (New York, N,Y.)

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“…In recent years, the application of the reverse digital proper artery island flap with anastomosis of the dorsal nerve or the dorsal branch of the proper digital nerve has become a more mature surgical procedure. 3,[7][8][9] The procedure has the advantages of easy acquisition, limited to the injured finger, and provides better aesthetic and functional recovery. However, the donor site is located on the dorsum of the finger, leaving the extensor tendon exposed, which may lead to adhesion of tendon, and noticeable scar contracture after surgery, 3 and loss of sensation in the donor area is inevitable.…”

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confidence: 99%

“…It can provide adequate and durable tissue without invading the palm or other fingers. In recent years, the application of the reverse digital proper artery island flap with anastomosis of the dorsal nerve or the dorsal branch of the proper digital nerve has become a more mature surgical procedure 3,7–9 . The procedure has the advantages of easy acquisition, limited to the injured finger, and provides better aesthetic and functional recovery.…”

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confidence: 99%

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

et al. 2023

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ObjectiveTo illustrate the clinical outcomes of the reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve for the reconstruction of finger pulp defects.MethodsFrom December 2007 to December 2017, a total of 20 patients with finger pulp defects were treated with reverse digital proper artery island flap for innervated construction. Functional outcomes, aesthetic appearance, and complications were evaluated. Functional outcomes were assessed according to range of motion, sensory grade (S0–S4), static 2-point discrimination, Semmes-Weinstein monofilament test, and Cold Intolerance Severity Score. Aesthetic appearance was evaluated according to the Michigan Hand Outcomes Questionnaire.ResultsAll flaps survived completely without any complications, and all patients were followed up for at least 12 months. The average static 2-point discrimination, Semmes-Weinstein monofilament, and Cold Intolerance Severity Score results of the injured fingers were 6.35 mm (range, 5–8 mm), 3.64 (range, 2.83–4.17), and 19 (range, 8–24), respectively. All patients achieved recovery in sensation from S3+ to S4. The active ranges of motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the affected fingers were satisfactory. Based on the Michigan Hand Outcomes Questionnaire, 11 patients were strongly satisfied, and 9 were satisfied with the appearance of the injured finger.ConclusionsThe reverse digital proper artery island flap with anastomosing the palmar cutaneous branches of the proper digital nerve is an effective and reliable alternative for the reconstruction of finger pulp defect. In the recovery of sensation, this flap leads to satisfactory effects.

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“…The reverse digital artery island flap (RDAF) provides good cosmetic appearance and sensory recovery, and RDAF is one of the most widely used surgical methods for fingertip defects. 1,2 The RDAF does not include digital nerves; therefore, sensory recovery depends on peripheral nerve regeneration around the flap. The extent of sensory recovery in the flap is unpredictable.…”

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confidence: 99%

Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction

Xiong

Ming

et al. 2021

Ann Plast Surg

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Objective: This retrospective study aimed to compare the clinical effects of reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in fingertip reconstruction. Patients and Methods: We retrospectively analyzed the data of 30 consecutive patients with fingertip defects who had undergone 2 types of surgery from January 2016 to January 2019. We used reverse digital artery island flaps and antegrade homodigital neurovascular island flaps in 14 and 16 patients, respectively. Flap sensitivity was evaluated using the Semmes-Weinstein monofilament test and static 2-point discrimination test. Finger appearance was assessed using the Michigan Hand Outcomes Questionnaire. The operation time, flap sensitivity, range of motion of the interphalangeal joint, and complications were evaluated. Results: The static 2-point discrimination results of the fingers were significantly different between the antegrade homodigital neurovascular island flap group and reverse digital artery island flap group (8.07 ± 1.54 vs 5.94 ± 1.73; P < 0.05). The appearance of the fingers was significantly better in the antegrade homodigital neurovascular island flap group. Surgery using antegrade homodigital neurovascular island flaps required less time than surgery using reverse digital artery island flaps. No significant differences were found between the 2 groups in the range of motion of the interphalangeal joint or complications. Conclusions: The functional outcomes were identical between the reverse digital artery island flap and antegrade homodigital neurovascular island flap methods for fingertip reconstruction. Antegrade homodigital neurovascular island flaps lead to a shorter operation time, a more satisfying appearance, and better sensory recovery.

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Postoperative Voluminal Flap Reduction After Fingertip Reconstruction Using the Reverse Digital Artery Island Flap

Cited by 3 publications

References 15 publications

Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap

Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

Comparative Study of the Clinical Effects of Reverse Digital Artery Island Flaps and Antegrade Homodigital Neurovascular Island Flaps for Fingertip Reconstruction

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