Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator

Abstract

Background:The purposes of this article are to introduce and assess the results of a long-term follow-up of using anterograde pedicle flap based on the dorsal branches of proper digital neurovascular bundles from the dorsum of the middle phalanx for the fingertip defect.Methods:Between February 2011 and December 2012, 31 patients underwent reconstruction of fingertip defects using a homodigital flap based on the dorsal perforator in the middle phalanx. The defect size ranged from 1.3 cm × 1.5 cm to 2.4 cm × 3.0 cm. During surgery, the flap was designed on the dorsal middle phalangeal region. The pedicle was a neurovascular bundle consisting of an artery, vein, and sensory nerve; the rotation of pedicle was <90 degrees.Results:The clinical results were satisfactory after 3 to 9 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The sensory recovery was excellent, 2-point discrimination was 4.96 ± 1.47 mm, and the recovery of range of motion of the interphalangeal joints was very good.Conclusions:The anterograde island flap based on the dorsal branches of proper digital neurovascular bundles is an ideal aesthetic reconstruction method for fingertip defect. A 90-degree rotated island pedicle flap was very versatile, easy to design, and had good survival. This technique is simple with less damage to the donor site, without sacrificing the branch of the digital artery and nerve. The reliable source of blood supply and satisfactory recovery of sensation can be achieved without affecting the interphalangeal joint activity.

Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options

“…Wei et al. 42 described 31 homodigital anterograde islanded pedicle flaps based on the dorsal perforators in the middle phalanx. 8 The blood flow is provided by the anterograde flow from the dorsal branches at the level of DIPJ (two to three perforators) but includes proper neurovascular bundle dissected within the flap.…”

“…Venous congestion seen in 39 flaps (7.87 %) resolved spontaneously but took up to five to seven days to resolve. 14 , 42 There were 21 partial flap losses (4.2 %) of which sixteen healed secondarily but two needed grafting and one needed revision surgery. Cold intolerance was reported only in 26 flaps (5.2 %) from the review, but Ayhan et al.…”

Repair of Fingertip Defect Using an Anterograde Pedicle Flap Based on the Dorsal Perforator

“…We read with interest the article by Wei et al 1 regarding the repair of fingertip defect using a flap based on the dorsal perforator.…”