Specific Complications Associated with Different Types of Intrinsic Pedicle Flaps of the Hand

Abstract

One hundred eight pedicle flaps intrinsic to the hand were performed in 98 male and 10 female patients averaging 36 years of age for digit-level trauma in 19 thumbs, 27 index, 50 long, 8 ring, and 4 small fingers. Specific flaps employed were 79 antegrade proper digital artery, 10 reverse proper digital artery, 6 reverse second dorsal metacarpal artery, 5 antegrade first dorsal metacarpal artery, 6 reverse dorsal ulnar artery of thumb, and 2 dorsal middle phalangeal flaps. The final average total active motion in the fingers was 235 degrees. Complications in 42 cases (39% actively smoking) included 10 partial flap losses, 13 cases of superficial epidermolysis, 4 cases of venous congestion, 4 superficial infections, 3 deep infections, and 8 cases of delayed healing at the wound margin. Second surgeries required were 3 debridements of deep wound infections, 3 revisions of the distal fingertip, and 9 full-thickness skin grafts. Specific associations of complications with flap type were between antegrade proper digital artery flaps and partial flap loss, epidermolysis, delayed wound healing, and infections at the distal margin but no cases of venous congestion. Reverse-flow flaps experienced venous congestion and epidermolysis but no partial flap losses or infection.

Reconstruction of Soft-Tissue Defects of the Thumb Using Reverse-Flow Homodigital Flaps: A Systematic Review

“…This left us unable to elucidate the complications specific to thumb reconstruction, thereby reducing the overall number of cases reviewed. 30 39 On evaluation of bias as per the criteria from the NIH quality assessment tool, only three studies had a high risk of bias. There was no uniformity on follow-up time, which varied from 3 to 46 months.…”

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

“…However, in clinical use, one is bound to meet some problems even with the most reliable flaps. 7) Local flaps are most commonly performed to cover traumatic defects. Poor design of the flap or imperfect execution of the operation may result in unnecessary reoperation.…”

“…Previous study reported a re-operation rate of 13.8% in a series of 108 pedicled flaps even after excluding VY-plasties. 7) The author state, that antegrade flow flaps suffered more often from partial ischemia and loss of the flap and retrograde flaps from venous congestions, but he did not declare the numbers to compare the number of re-operations of different flaps.…”