A New Triangular Rotation and Advancement Pulp Flap for Lateral Oblique Fingertip Defect

Abstract

Background: The fingertip is one of the most common sites of traumatic injuries faced by hand surgeons. In cases of lateral oblique amputation, only limited alternatives are available for reconstruction. This study introduced a new method involving rotation and use of an advancement pulp flap for covering lateral oblique defect and evaluated its outcome. Method: A series of 12 patients with 14 lateral oblique fingertip defects were recruited in this study. All fingertips were unreplantable and were injured distal to the proximal one-third of nail bed, with phalanx exposed. All cases received surgical reconstruction using a triangular rotation and advancement pulp flap. Static 2-point discrimination, cold intolerance, pain, hypersensitivity, range of motion, and aesthetic satisfaction were evaluated 6 months to 12 months postoperation. Result: Bone defect was noted in 7 cases. The area of defect was 10×7–20×12 mm2, and the angle of defect was 30–60 degrees. Mean follow-up was 14.3 months. No hook nail deformity, cold intolerance, and hypersensitivity were observed. One patient complained about pain postoperation, demanding a second operation. Static 2-point discrimination was between 5 and 8 mm in all cases. Range of motion of distal interphalangeal joint recovered to 20–45 degrees at the last follow-up. No stiffness was observed in the interphalangeal or metacarpophalangeal joints. All patients were satisfied with the appearance of the flap. Conclusion: The triangular rotation and advancement pulp flap is simple, safe, and reliable for treating lateral oblique defect of fingertip, providing scope for anatomical reconstruction and fair sensation and aesthetic recovery.

Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries

“…Fibrofatty tissue (only) is sutured under the nail and the skin defect is allowed to heal secondarily. Several types of rotational pulp flaps have been used to cover lateral oblique defects, including the 'Soquet' or 'Hueston' rectangular pulp flaps (Foucher et al, 1994;Lloyd and Sammut, 2013), curved pulp flaps (Ozturk et al, 2016;Tuncali et al, 2006) and triangular pulp flaps (Zhou et al, 2020). Their common features include a need for full flap elevation from the phalanx, flap rotation and finally, the significant size of the distal defective area may remain uncovered and thus be left to heal secondarily.…”

“…The treatment of lateral oblique fingertip defects differs from those of transverse amputations because of their unique anatomical and asymmetrical geometric features. Other flaps for these defects include lateral pulp flaps (Elliot and Jigjinni, 1993), rotational pulp flaps (Lloyd and Sammut, 2013;Ozturk et al, 2016;Zhou et al, 2020), a dorsal transposition flap (Ogunro, 1983), lateral perforator flaps (Shen et al, 2015) and homodigital direct-flow island flaps (Venkataswami and Subramanian, 1980). These flaps are more complex, and some may require skin grafting of the donor site.…”

Negative Pressure Wound Therapy for Gas Gangrene of the Fingertip with Prolonged Infection

“…Treatment methods for soft tissue injuries with defects are generally covered with a skin flap, stump-plasty, and conservative therapy using dressings. 8 Conservative therapy using film dressings and aluminum foil is occasionally administered, which takes approximately 2–12 weeks to heal. 8 NPWT use started in the early 1990s, 9 and satisfactory outcomes have been reported owing to increased granulation speed in the wound healing process.…”

“… 8 Conservative therapy using film dressings and aluminum foil is occasionally administered, which takes approximately 2–12 weeks to heal. 8 NPWT use started in the early 1990s, 9 and satisfactory outcomes have been reported owing to increased granulation speed in the wound healing process. 1 , 2 NPWT is used on open wounds; it decreases the frequency of painful wound treatments and can reduce the treatment period by half.…”

Modified Volar Oblique Triangular Flap for Coverage of Fingertip Defects

“…1,3 According to Fassler geometry classification fingertip may be injured transverse, radial or ulnar oblique and volar or dorsal oblique. 1,7 Though availability of adjacent tissue is less, a wide range of reconstruction procedures are available, ranging from STSG to distant flap. To meet the goal of the reconstruction principle, "Like with Like" local flap is the most preferable.…”