Expanded Utilization of the Digital Atasoy Flap

Background: Atasoy flaps (AFs) are commonly used to reconstruct digits after fingertip injuries. However, recent literature reports that some surgeons prefer skeletal shortening and closure, presumably because the procedure can be performed in the emergency department without the risk of flap-associated complications. The purpose of the present outcome study is to evaluate patient-reported, long-term satisfaction of AF reconstructions for fingertip injuries. Methods: Adult, male patients working in manual labor occupations who underwent AF reconstruction for fingertip injuries were identified from an institutional database. Patients were administered an injury-specific questionnaire relating to nail growth, function, aesthetics, cryalgia, and hypersensitivity. They were then administered the QuickDASH questionnaire to report standardized functional impairment and asked about their overall satisfaction with their reconstructed finger. Results: Twelve patients underwent AF fingertip reconstruction between 2015 and 2020. Eleven of these patients agreed to be interviewed, the majority having been treated in the emergency department setting. The overall satisfaction rate was 91% (n = 10). Common sequelae included hook nail 64% (n = 7), cold sensitivity 45% (n = 5), and hypersensitivity 27% (n = 3). There were no flap failures or tissue necrosis. One patient reported a second surgery for improvement of a hook nail deformity. Conclusions: Long-term outcomes of AF reconstruction for fingertip injuries demonstrate high overall satisfaction. Patients appreciated tissue salvage to preserve digit length, even in those unconcerned with aesthetics. Issues reported by patients, such as cold intolerance, hook nail, and decreased tactile sensation, are similar to other treatment options for fingertip injuries.

Section: Discussionmentioning

confidence: 99%

Atasoy Flap Fingertip Reconstruction: Long-term Patient-reported Outcomes in Male Laborers

Franke

Kraft

Mailey

2022

“…In patients with diabetes mellitus with vascular involvement, consideration should be given to a surgical delay of the flap by incising through skin only and completion of the flap at 14 days. 12 When closing areas with exposed vital tissues or exposed bone, or areas at risk for contamination such as pilonidal disease, fasciocutaneous flaps are more robust and, therefore, more protective than cutaneous flaps.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Section: Indications and Contraindicationsmentioning

confidence: 99%

Dufourmentel Flap for Scalp Reconstruction

Viciana

Lessard²

2022

Self Cite

Summary: Transposition flaps are useful for reconstruction of many skin defects. Limberg described a rhomboid rotation flap in 1946. Dufourmentel described an improved version of the Limberg flap in 1962. The Dufourmentel flap is also a quadrangular rhomboid flap which can be used in any area of the body except for the central face, the fingers, and the volar hand. The design of the Dufourmentel flap creates a wider base for this random flap, thus making it more reliable. Where tissue loss is significant, or where skin and soft tissue elasticity is limited, double opposing Dufourmentel flaps are useful. A variation of the Dufourmentel flap is described where a circular defect is converted to a square. The line of greatest extensibility is marked through the circular defect or lesion. A square is marked around the circle with one corner of the square tilted 10–20 degrees counterclockwise from the line of greatest extensibility. After marking corners A, B, C, and D, lines are marked extending BD and CD. The first incision, DE, will bisect the angle created by extending BD and CD. The second incision, EF, is roughly perpendicular to CD extended, but the angle at E is opened up a bit to create a wider base for the flap. Point D will rotate to point B, E rotates to C, and F translates to D. The invisible line DF should be approximately parallel to the line of greatest extensibility. When the defect is relatively large or where the surrounding tissues have limited elasticity, the above-described ideal variation of the Dufourmentel flap may not be possible because the flap may not rotate and advance all the way around without tension. In this case, double opposing Dufourmentel type flaps have been found to be useful by meeting each other at the halfway point.

“…Patients with potential for poor wound healing include those with diabetes mellitus, Raynaud’s disease, severe peripheral vascular disease, or connective tissue diseases, such as scleroderma, systematic lupus erythythematosus (SLE), dermatomyositis, and calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome. 14 The complete clinical picture, however, should be considered. If the patient is not infirm and their underlying disease is well-controlled, then a flap repair is indicated.…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

V-Y Flap for Nasal Reconstruction

Viciana

Lessard

2020

Self Cite

The nasal tip is a complex zone for reconstruction. Numerous flap reconstructions have been proposed. In addition to the technique presented here, only the Gillies-Millard bishop’s miter flap and the paramedian forehead flap should be considered. The bilobed flap should be discontinued. The double-opposing V-Y flap for nasal tip reconstruction described here is an excellent method for reconstruction of limited defects of the nasal tip. These are mirror-image cutaneous flaps which require careful, skillful technique to preserve the delicate nerves and vessels. This challenging technique should only be attempted by qualified surgeons. Triangular cutaneous flaps are marked on either side of the defect, oriented transversely. The flaps are elevated and advanced with careful, gentle dissection. Ligamentous structures are cut while preserving the neurovascular supply. No cautery is used. The procedure is performed in an operating room with local anesthesia and with the patient under IV sedation. A patient who underwent this reconstruction is shown preoperatively, early postoperatively, and late postoperatively. The results demonstrate no tip distortion with imperceptible scars. The steps to undertake this procedure are outlined in detail. Rules for nasal tip reconstruction are proposed.