Innervated Reconstruction of Fingertip Degloving Injury Using a Dorsal Digital Perforator Flap Combined With a Cross-Finger Flap

Abstract

BackgroundThe reconstruction of a fingertip degloving injury presents a functional and aesthetic challenge. We used a dorsal digital perforator flap combined with a cross-finger flap to reconstruct this type of injury. The purposes of this retrospective study were to evaluate the efficacy of the combined flaps and to present our clinical experience.MethodsFrom November 2016 to October 2019, 16 patients (13 men and 3 women) with fingertip degloving injuries were treated with a dorsal digital perforator flap combined with a cross-finger flap for innervated reconstruction. We used an innervated dorsal digital perforator flap for the reconstruction of the dorsal defect of the degloved fingertip and an innervated cross-finger flap for the volar defect. The average size of the defect was 4.2 × 1.9 cm. The average sizes of the flaps were 2.3 × 2.1 cm (the dorsal digital perforator flap) and 2.5 × 2.1 cm (the cross-finger flap).ResultsAll flaps and skin grafts survived completely without ischemia or venous congestion. All wounds and their donor sites healed primarily without exudation and infection. Patients were followed up for a mean time of 11.3 ± 1.9 months (range, 9–15 months). At the final follow-up, no significant difference was seen in the averaged total active motion between the injured fingers and the contralateral fingers. No significant difference was found in the averaged total active motion between the donor fingers and the contralateral fingers. All flaps obtained excellent or good sensory performance. All flaps had mild cold intolerance. Thirteen patients had no pain, 2 reported mild pain, and 1 experienced moderate pain. Ten patients were very satisfied with the appearance of the reconstructed finger.ConclusionsThe dorsal digital perforator flap combined with a cross-finger flap is an effective and reliable method for the reconstruction of fingertip degloving injuries.

Repair of Finger Pulp Defect and Sensory Reconstruction Using Reverse Homodigital Artery Island Flap With Palmar Cutaneous Branches of the Proper Digital Nerve

“…The digital dorsal flap combined with the cross-finger flap is an effective and reliable method, which can be used to repair the fingertip degloving injury. However, 3 weeks of immobilization and a second operation are still unavoidable 13,14 . V-Y advancement flap is appropriate for a small soft-tissue defect, which can obtain satisfactory wear resistance, appearance, and sensory recovery without causing damage to the donor area 15 .…”

“…V-Y advancement flap is appropriate for a small soft-tissue defect, which can obtain satisfactory wear resistance, appearance, and sensory recovery without causing damage to the donor area 15 . Although the technique remains one of the most secure and popular reconstructive options with overall good results, it should not be advanced more than 15 mm distally 14,16,17 . Abdominal flaps can repair large areas of finger defects, as well as multiple or complex defects.…”

“…However, 3 weeks of immobilization and a second operation are still unavoidable. 13,14 V-Yadvancement flap is appropriate for a small soft-tissue defect, which can obtain satisfactory wear resistance, appearance, and sensory recovery without causing damage to the donor area. 15 Although the technique remains one of the most secure and popular reconstructive options with overall good results, it should not be advanced more than 15 mm distally.…”

Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap

“…These choices cover small to moderate digital defects, such as homodigital, heterodigital, cross-finger flap, thenar flap, and hypothenar flap. Still, these flaps have several limitations of flap size and can compromise the function of an otherwise noninjured finger 19–24 . Some distal flaps, such as reverse radial forearm flap or posterior interosseous artery flap, cross-arm flap, and pedicled abdominal flap, offer a reconstructive alternative but still have some drawbacks.…”

“…Still, these flaps have several limitations of flap size and can compromise the function of an otherwise noninjured finger. [19][20][21][22][23][24] Some distal flaps, such as reverse radial forearm flap or posterior interosseous artery flap, cross-arm flap, and pedicled abdominal flap, offer a reconstructive alternative but still have some drawbacks. The clinical manifestations of complete degloving or semicircumferential injuries differ from the blast and the pure crush mechanism, as the soft tissue envelope is disproportionately injured.…”