Flap Related Complications Requiring Secondary Surgery in a Series of 851 Local Flaps Used for Fingertip Reconstruction

Abstract

Background: Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues. Methods: 851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis. Results: 31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis. Conclusions: Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.

Fingertip amputation injury managed conservatively with moist wound dressings

“…5,6 However, operative management is preferred over conservative in Asian countries. 5,7 In Japan, replantation and reconstruction are the major strategies for fingertip amputations; 8-10 however, conservative management using moist wound dressings has become more common in recent years. 4 In the current case, a plastic surgeon recommended surgery during the initial visit; however, the patient chose conservative management because, after thoroughly reviewing medical articles regarding the treatment of fingertip injuries, she believed that conservative management would bring better outcomes rather than surgery.…”

Bilateral Free 2nd Toe Pulp Flap for Reconstruction of Soft Tissue Defect in Traumatic Finger Injuries

“…The fingertip possesses unique characteristics. A successful reconstruction should achieve adequate skin and soft tissue volume, sufficient resistance against trauma and friction [11]. Skin grafts are avoided because it results abnormal appearance, poor sensation, and splitting in the cold of winter [2].…”

“…These local flaps can often be successful, but often result in re-operation due to poor flap design or traumatic dissection. Moreover, each type of flaps has its own disadvantages to consider [11]. Homodigital island flaps from the dorsum have limited pedicle length that restricts their use.…”

Colgajo local de patrón aleatorio para cobertura de resección de liposarcoma de tejidos blandos de extremidad superior

“…Las porciones de un colgajo más vulnerables a la necrosis son la punta distal, ya que tiene menos vasos sanguíneos para nutrirlo y está más distante de la arteria o arteriola de alimentación y de la porción del colgajo suturada, ya que la tensión del cierre da como resultado fuerzas de compresión en los vasos sanguíneos. 12 El sistema toracodorsal y torácico lateral ha proporcionado colgajos durante la evolución de la cirugía reconstructiva. Varios artículos presentan colgajos de la zona.…”