Combined usage of hydroxyapatite and cross-finger flap for fingertip reconstruction

Abstract

Reconstruction for fingertip defects categorized as Type 3 and Type 4 in Allen's classification is challenging, because surgeons need to reconstruct not only the pulp but also great parts of the distal phalangeal bone. This paper introduces an original technique for the reconstruction of defects of these types. The defects of seven fingers (two small fingers and five index fingers) of seven patients (three males and four females; aged 14-44 years) were repaired. After the fingertip is divided in a fish-mouth fashion to expose the stump of the distal phalangeal bone, a curved block of hydroxyapatite is grafted to fill the phalangeal defect and straighten the nail bed. A rectangular flap is raised from the dorsal side of the neighbouring finger in the region between the PIP and DIP joints. Then the fish-mouth region carrying the grafted hydroxyapatite is covered with the rectangular flap to reconstruct the pulp. The rectangular cross-finger flap is separated 3-4 weeks postoperatively. In all seven cases, the flap survived completely. Infection developed in no case. In all cases, aesthetic appearance of the pulp and nail presented improvement, satisfying the patients. Combined usage of hydroxyapatite and a cross-finger flap from the neighbouring finger is an effective method for the reconstruction of type 3 and type 4 defects in Allen's classification.

The modified second toe flap technique based on the dorsal digital artery of the toe in finger pulp reconstruction

“…Several options for treatment of fingertip defects are used in different kinds of injuries because of their distinctive advantages. Heterodigital flaps, homodigital flaps, thenar flaps, and free flaps are widely used in fingertip amputations (Lim et al, 2019; Lim & Chung, 2020; Miller & Friedrich, 2016; Nagasao et al, 2014; Petrella et al, 2021; Pham & Netscher, 2015). The primary goal is to cover the exposed wound with skin and soft tissue and salvage the length of fingers as much as possible.…”

“…The 2-PD was 12 mm, however, the appearance of his nail bed was not satisfactory (Figure 3f). Friedrich, 2016; Nagasao et al, 2014;Petrella et al, 2021;Pham & Netscher, 2015). The primary goal is to cover the exposed wound with skin and soft tissue and salvage the length of fingers as much as possible.…”

Time of return back to work and complications following cross-finger flaps in industrial workers: Comparison between immediate post operative mobilization versus immobilization until flap division

“…Regardless of the technique, all previous authors immobilized the hand or the operated digits until flap division. Complete immobilization was employed for 10 days [6] , [7] , 14 days [1] , [2] , [8] , [9] 18 days [10] , [11] , and 21 days [12] , [13] , [14] , [15] , [16] , [17] . One series employed early partial mobilization (the exact details of this partial mobilization were not stated) until flap division at 24 days, at which time full mobilization was started [18] .…”