Preventing Postoperative Congestion in Reverse Pedicle Digital Island Flaps When Reconstructing Composite Tissue Defects in the Fingertip: A Patient Series

Matsuzaki, Hiroyuki; Kouda, Hisao; Yamashita, Haruyoshi

doi:10.1142/s0218810412500128

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…Compared to other pulp repair methods, anterograde advancement flap repairs are known to provide a better sensory restoration. [ 25 ] Particularly, sensory reconstruction is more straightforward in advancements shorter than 12 mm. [ 12 ] Flap neurotization is necessary for reverse flow methods in fingertip reconstruction to enhance sensation, which extends operation time and complicates the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations

Ceran

2024

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss. METHODS: Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed using the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postoperatively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively. RESULTS: Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5. CONCLUSION: The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

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Section: Discussionmentioning

confidence: 99%

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations

Ceran

2024

Ulus Travma Acil Cerrahi Derg

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“…Perforator-based propeller flaps provide a reliable option for covering small- to medium-size hand complex tissue defects [ 16 – 18 ]. They have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, and the donor site can be sometimes closed directly [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Propeller Perforator Flaps in Hand Reconstruction: The effect of blood vessel twisting

Filip

Muntean

Dumitraşcu

et al. 2015

Medicine and Pharmacy Reports

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Background and aimsPerforator flaps increasingly find acceptance and use in hand reconstructive surgery. A propeller flap is an island flap that moves from one orientation to another by rotating around its vascular pedicle. It is now possible to design propeller flaps based on a single perforator, so-called “perforator-based propeller flaps,” but they are more prone to vascular impairment when twisted more than 90°.MethodsWe present a prospective study conducted in the Plastic and Reconstructive Surgery Department of the Rehabilitation Hospital over 17 months. All perforator-based propeller flaps that were used for hand reconstruction were analyzed. The parameters studied included the size and location of the defect, the size and shape of the flap, the perforator (length and location) that was used, the degree of twisting of the perforator, the degree of perforator dissection, the management of the donor site, and flap survival area.ResultsIn this study we investigated the circulatory impairment induced by twisting of the pedicle on a true perforator flap. All flaps survived completely with the exception of partial skin necrosis in few cases. Some of these cases required debridement and skin grafting.ConclusionsPerforator-based propeller flaps provide a reliable option for covering small- to medium-size hand complex tissue defects. They have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, and the donor site can be generally directly closed.

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“…General reasons for failure of pedicle flaps are reported to be pedicle torsion, spasm related to dissection, and compression of the pedicle attributable to postoperative dressings (Henry and Stutz, 2006). It is also said that the width of the pedicle involving the digital artery, nerve, and adjacent vessels should be kept at 3-4 mm for smooth venous drainage and prevention of vein congestion (Matsuzaki et al, 2012). The vein congestion observed in our series was considered as the result of injury to the structures adjacent to the pedicle caused by crushing forces rather than the result of injury to vessels occurred at the time of pedicle dissection.…”

Section: Discussionmentioning

confidence: 99%

Modified anterograde pedicle advancement flap in fingertip injury

Lee

Jang

Kim

et al. 2014

J Hand Surg Eur Vol

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Soft tissue reconstruction is needed to maintain the maximum length of the fingers in fingertip injury. The purpose of this study was to present an anterograde pedicle advancement flap technique, for the treatment of fingertip injuries, which involved a modification to the anterograde advancement flap by the dissection of the digital nerve and artery with a pedicle to advance the flap. This technique was used in 12 fingers in patients who had undergone soft tissue reconstruction of fingertip injuries between January 2012 and October 2013. The sizes of the flaps ranged from 8 × 7 mm to 14 × 10 mm. The mean length of advancement was 9.7 mm (range 7-13). The mean value of the static two-point discrimination test of the healed flaps was 5.1 mm (range 4-6) and the flaps survived in all the 12 cases. The modified anterograde pedicle advancement flap provides a reliable coverage of sensate soft tissue without bone shortening in fingertip injuries.Level II.

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Preventing Postoperative Congestion in Reverse Pedicle Digital Island Flaps When Reconstructing Composite Tissue Defects in the Fingertip: A Patient Series

Cited by 8 publications

References 5 publications

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations

Propeller Perforator Flaps in Hand Reconstruction: The effect of blood vessel twisting

Modified anterograde pedicle advancement flap in fingertip injury

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