Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

Abstract

The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n = 765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4-36 months). The wider pedicled fascial flap (1.0-1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds.

Reconstruction of complex nail matrix defect using the homodigital reverse fasciocutaneous flap

“…Skin or nail matrix grafting alone is not enough to reconstruct this complex tissue defect due to its exposure of bone and tendon. [ 18 , 19 ] Major reconstructive methods are regional flaps and free composite tissue transfers. One of the regional flaps is the homodigital reverse digital artery island flap, which may produce cold intolerance as a result of sacrificing 1 digital artery.…”

“…The dorsal branches of the proper digital artery have 4 major branches, which arise at the level of the middle and distal one-third sites of the proximal phalange, in the middle phalange site, and at the level of the DIP joint site. [ 13 , 19 , 21 ] Flap venous congestion is regarded as a major postoperative complication. [ 22 ] The venous flow of this flap is drained mainly through the subcutaneous venous network, and the associated superficial venous trunk plays an important role, which results in no or little venous congestion.…”

“…[ 22 ] The venous flow of this flap is drained mainly through the subcutaneous venous network, and the associated superficial venous trunk plays an important role, which results in no or little venous congestion. [ 19 ] In our cases, an appropriate skin strip over the pedicle was preserved to protect the subcutaneous veins and avoid pedicle compression after flap transfer, thus leading to excellent venous drainage. No significant venous congestion occurred in our series, and all flaps survived well.…”

The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

“…Free toenail flap transplantation is a difficult operation with high risk, great damage to patients, and high requirements for surgeons (2)(3)(4)(5)(6). At present, the digital dorsal fascial island flap has been widely used to repair the soft tissue defect of the dorsal or ventral finger (7)(8)(9)(10). The crossfinger flap can repair the soft tissue defect of finger palmar and reconstruct the flap sensation, and it has the advantages of simple operation and low-operation risk (11,12).…”