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

Abstract

Background: The management of contractures and soft tissue defects in the proximal interphalangeal (PIP) finger joint remains a challenge. We report a transposition flap from the lateral skin of the proximal phalanx that is based on perforating branches of the digital arteries and can be used safely for both palmar and dorsal cover defects. Methods: We first completed an anatomic study, dissecting 20 fingers in fresh cadavers with arterial injections and made the new flap in patients with dorsal or palmar defects in PIP joints. Results: In cadavers, we can reveal 4 constant branches from each digital artery in the proximal phalanx, with the more distal just in the PIP joint constituting the flap pedicle. Between February 2010 and February 2015, we designed 33 flaps in 29 patients, 7 for dorsal and 26 for palmar defects, with no instances of flap necrosis and 4 distal epidermolysis. The patients were between 4 and 69 years with no major complications, and all of the skin defects in the PIP joint were resolved satisfactorily without any relevant sequelae at the donor site. Conclusions: This flap procedure is an easy, reliable, versatile, and safe technique, and could be an important tool for the management of difficult skin defects and contractures at the PIP joint level.

The free neurovascular transverse wrist crease flap for repairing soft tissue defects of the fingers: clinical outcomes of multiple centers

“…It is a common problem that traumatic soft tissue defects of the finger need to be reconstructed with flap procedure [17–19]. The flap procedure should not produce severe side effects on the donor site and should be suitable to reconstruct the soft tissue defects.…”

Double Stiletto Flap for Soft Tissue Cover as a Firebreak Following Contracture Release of Digits and Full-Thickness Grafting: A Surgical Technique

“…They described the lateral proximal phalangeal flap based on the third and fourth branches or the fourth branch independently, for soft tissue cover after PIP contracture release and reported good outcomes over a mean follow-up of 4 months. 21 Bertelli and Nogueira used an island flap from the dorsum of the proximal phalanx based on a perforator from the PDA, for soft tissue coverage after contracture release, in 12 fingers of 11 children with recurrent burns contracture. Though they did not report on the severity of the contractures in the digits treated, they reported good outcomes with their technique over a mean follow-up of 20 months.…”

Skin Closure After Subtotal Aponeurectomy in Severe Dupuytren’s Contracture: Review

“…Способы замещения дефектов кожи кисти после апоневрэктомии можно разделить на следующие виды: использование свободного полнослойного кожного трансплантата, местная кожная пластика и регионарные лоскуты [41,42,43,44,45].…”