Finger amputations and pulp defects distal to the distal interphalangeal joint

Tos, Pierluigi; Adani, Roberto

doi:10.1177/1753193419873554

Cited by 17 publications

(12 citation statements)

References 11 publications

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“…One of the major benefits of this flap is that this is sensate. Pulp sensation is of prime importance in digital soft tissue repair (Lam and Jordan, 2019; Omokawa, 2019; Tang 2019; Tang et al., 2014; Tos and Adani, 2019). This sensate flap that we used achieved functional sensibility with a mean s2PD of 6.7 mm (range 3 to 13) and m2PD of 5.1 mm (range 2 to 10).…”

Section: Discussionmentioning

confidence: 99%

“…For ideal soft tissue reconstruction of the volar surface of the digit, glabrous skin with similar texture, contour, suitable thickness, durability for pinch and grip and, if possible, the ability to restore sensation, is required. Traditionally, antegrade volar advancement flaps, homodigital reverse pedicle flaps, heterodigital neurovascular island flaps and cross-finger flaps have been commonly used (Elliot et al., 2018; Germann et al., 2017; Lam and Jordan, 2019; Lim et al., 2019; Omokawa, 2019; Tang et al., 2014; Tos and Adani, 2019). However, local flaps are not always large enough to cover the defect.…”

Section: Introductionmentioning

confidence: 99%

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An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

Usami

Inami

Hirasé

et al. 2020

J Hand Surg Eur Vol

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We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the proximal digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

Usami

Inami

Hirasé

et al. 2020

J Hand Surg Eur Vol

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“…20 Furthermore the coverage of the fingertip can be obtained with island advancement flaps based on collateral digital artery and nerve that provide a sensory like-to-like reconstruction of the fingertip. 21,22…”

Section: Bilobed Digital Perforator Propeller Flapsmentioning

confidence: 99%

Propeller Flaps for Hand and Digit Reconstruction

et al. 2020

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The reconstruction of soft tissue defects of the hand, as seen often after trauma or tumor excision, is a challenge due to the great differentiation of tissues depending on the hand area involved. The classical intrinsic “workhorse flaps” of the hand are associated with a significant donor-site morbidity. Capturing perforator vessels in discrete donor areas can reduce the amount of soft tissue that has to be dissected and included in what now would be a perforator flap, while also insuring robust vascularization of those transferred tissues. Moreover, the presence of perforator vessels both on the dorsal and volar sides of the hand allows harvest of perforator flaps that will respect the like-with-like principle by maintaining the main characteristics of volar and dorsal skin as desired. However, the dissection of these flaps, especially those based on volar palmar and digital perforators, still requires microsurgical skills to preserve the fine vascularization of these flaps. These small flaps are also amenable for application of the propeller flap concept. This is an especially valuable means for preserving the length of an amputated finger where bone is exposed by using more proximal uninjured tissues. Although in general only a short dissection is required to raise a propeller flap in this region, most often the donor site will have to be closed by a skin graft.

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“…Such defects require glabrous and sensate skin coverage, especially when bone and tendon are exposed. Treatment methods include occlusive dressing coverage, local homodigital or heterodigital flaps and free flaps (Adani et al., 2005; Ipsen et al., 1987; Lee et al., 2020; Tang, 2019; Tang et al., 2014; Tos and Adani, 2019; Wang et al., 2020).…”

Section: Introductionmentioning

confidence: 99%

Fingertip defect reconstruction with a modified pivot flap

Petrella

Tosi

Sapino

et al. 2020

J Hand Surg Eur Vol

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The pivot flap can treat volar oblique defects of the fingers distal to the distal interphalangeal joint. We present our experience in 11 fingers (11 patients) using this flap, including some modifications that optimize flap harvesting, mobilization, inset, and vascular supply and outcomes. The flaps harvested had an average size of 2.4 × 2.0 cm. The patients were followed for an average of 21 months (range 12 to 36) after surgery. Sensitivity of the flap was evaluated with the Semmes–Weinstein monofilaments test and static two-point discrimination test. Cold intolerance was also evaluated. The pivot flap with the modifications demonstrates a reliable technique for fingertip defect reconstruction. The results, in terms of sensitivity and functional recovery, seem promising. Level of evidence: IV

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Finger amputations and pulp defects distal to the distal interphalangeal joint

Cited by 17 publications

References 11 publications

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction

Propeller Flaps for Hand and Digit Reconstruction

Fingertip defect reconstruction with a modified pivot flap

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