Refining the cross-finger flap: Considerations of flap insetting, aesthetics and donor site morbidity

Chong, Chew-Wei; Lin, Chih-Hung; Lin, Yu‐Te; Hsu, Chung-Chen; Chen, Shih‐Heng

doi:10.1016/j.bjps.2017.11.014

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Nevertheless, this study displays the advantages of primary closure of DMCA flaps concerning sensitivity, aesthetics, and trophic level of donor site, making this our recommended technique. Chong et al 25 agree when they described the reduction of donor site morbidity in cross-finger flaps by direct closure without skin grafts 25 …”

Section: Discussionmentioning

confidence: 86%

“…Chong et al 25 agree when they described the reduction of donor site morbidity in cross-finger flaps by direct closure without skin grafts. 25 Postoperative pain played a minor role, especially in the patients' subjective assessment. Patients with Foucher's flaps complained of the donor site pain, whereas patients with DMCA flaps seemed to suffer the most.…”

Section: Discussionmentioning

confidence: 99%

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Donor Defect Morbidity of Intrinsic Flaps in the Posttraumatized Hand

et al. 2021

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Introduction There are many types of intrinsic flaps to cover wound defects on the hand, which have been well described in scientific literature. However, the donor sites are often neglected in such studies. Therefore, we aimed to evaluate donor site morbidity for homodigital island flaps, cross-finger flaps, Foucher's pedicle flaps, and flaps of the dorsal metacarpal artery system (DMCA). Materials and Methods A total of 106 intrinsic flap procedures were performed on 106 patients (16 women, 90 men). The donor sites were retrospectively followed up after an average of 3.4 years by a questionnaire, a Disability of the Arm, Shoulder and Hand score, and clinical examination. Donor sites of different flap types were compared for aesthetic outcome, trophic level, and sensation, including 2-point discrimination, temperature, sharp/dull discrimination, the Semmes-Weinstein monofilament test, pain (visual analog scale), and functionality. Results In general, primarily closed donor sites showed more favorable results than did grafted donor sites. Satisfaction among patients regarding aesthetics of the donor site was highest in patients who had received homodigital island flaps. Grip strength and pain at the operated hand were very heterogeneous and rather influenced by the primary trauma than the type of flap. Homodigital island flap donor sites demonstrated the best results for 2-point discrimination and sharp/dull discrimination, and those for DMCA flaps in the Semes-Weinstein test. Conclusions Overall, intrinsic flaps demonstrated low donor site morbidity with reliable coverage of the defects. Of these, the DMCA (especially after primary closure) and homodigital island flaps seemed to produce the best donor site results.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Donor Defect Morbidity of Intrinsic Flaps in the Posttraumatized Hand

et al. 2021

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“…The aspect ratio (length to breadth) of the flap was larger than that of a random-pattern flap, and the maximum aspect ratio exceeded 3:1. The donor site was closed primarily with better aesthetics and less morbidity than the traditional cross-finger flap [29]. The nutrient vessels of the cutaneous nerve form a vascular network including intrinsic parallel vessels and the perforators of the extrinsic blood vessels.…”

Section: Discussionmentioning

confidence: 99%

Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger

Chen

Jiang

et al. 2019

BMC Surg

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BackgroundWhen restoring the appearance and function of the fingers, hand surgeons face a challenge in choosing a suitable surgical method to repair finger skin defects.MethodsIn this study, we designed a long elliptical flap based on a propeller perforator flap and located slightly toward the dorsal lateral aspect of the finger. The flap with a pedicle consisting of the dorsal perforator of the distal digital artery and dorsal digital artery perforator chain is rotated to cover a large wound on the distal end. From December 2014 to December 2017, 10 patients with finger soft tissue defects were treated with the propeller perforator flap described in this study.ResultsAll flaps survived after surgery, and 2 had a transient venous congestion. After a follow-up period of 3 to 12 months, the static two-point discrimination of the flap was 8.06 ± 1.75 mm, and the range of motion was 149.4 ± 12.9°. This designed flap can span several angiosomes supplied by the perforators. Due to the inclusion of a vessel chain between the dorsal digital artery perforators, the length-to-width ratio of the flap can be up to 3:1.ConclusionsThis technique increases the size of flap that can be harvested safely while retaining a reliable blood supply. The present study describes a new method for repairing soft tissue defects of the finger by using the technique of propeller perforator flaps based on dorsal digital artery perforator chains.Trial registrationThe registration number of this study is ChiCTR1800014588; it has been retrospectively registered with Chinese Clinical Trial Registry (chictr.org.cn), 18/11/2019.

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“…In addition, long-term follow-up of cross-finger flap technique reported very good sensory recovery. 21,22 When two-point discrimination results were compared between the innervated flap and the reverse island flap, the neurovascular island flap was superior at the initial stage, but there was no difference at the end of follow-up. Rabarin et al reported a long-term follow-up of 19.7 years with no pain at the donor site, especially in the fingertip, and no neuralgia, necrosis, or wound abnormality.…”

Section: Discussionmentioning

confidence: 99%

Reverse digital artery cross-finger flap for reconstruction of failed finger replantation

Kim

Seo

Lee

et al. 2018

J Orthop Surg (Hong Kong)

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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.

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Refining the cross-finger flap: Considerations of flap insetting, aesthetics and donor site morbidity

Cited by 8 publications

References 14 publications

Donor Defect Morbidity of Intrinsic Flaps in the Posttraumatized Hand

Donor Defect Morbidity of Intrinsic Flaps in the Posttraumatized Hand

Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger

Reverse digital artery cross-finger flap for reconstruction of failed finger replantation

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