Thumb fingertip reconstruction with palmar V–Y flaps combined with bone and nail bed grafts following amputation

Zhou, Xiao; Wang, Libo; Mi, Jingyi; Xu, Yang; Rui, Yongjun; Xue, Mingyu; Shen, Xiaofang; Qiang, Li

doi:10.1007/s00402-015-2163-4

Cited by 14 publications

(5 citation statements)

References 11 publications

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“…7,8 Reconstruction of the thumb tip injury has various options. 6,9,10 Whenever possible and feasible, reimplantation of the amputated part is the option for reconstruction. Other options include free pulp transfer, free toe transfer, neurovascular islanded pedicled flap, Moberg's flap, Brunelli's flap, cross-finger flap, etc.…”

Section: Discussionmentioning

confidence: 99%

Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation

Jayachandiran,

Rajendran,

Mahipathy

et al. 2024

Indian J Plast Surg

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Thumb tip injuries constitute one of the most common hand injuries. There are various reconstructive options for thumb tip injuries. We present our series of thumb tip injuries reconstructed using Elliot's modiﬁcation of the Moberg ﬂap, which provides like-for-like tissue. We also present our flap improvisation, which can be useful in the armamentarium of plastic surgeons. Background Moberg described the advancement ﬂap for thumb defects in 1964, which was modiﬁed by O'Brien in which the proximal part of the ﬂap is incised and advanced. Although it is a popular ﬂap, it has the disadvantage of interphalangeal (IP) joint ﬂexion deformity. Among the various modiﬁcations of the Moberg ﬂap, Elliot's ﬂap provided more tissue with minimal donor site morbidity and no usage of skin grafts or ﬁrst web skin. Methods We retrospectively analyzed the patients who underwent reconstruction of thumb defects by Elliot's modified Moberg's ﬂap. The size of the defect, etiology, and IP joint movement were analyzed. Two patients underwent our improvised ﬂap where a daughter ﬂap was elevated within Elliot's ﬂap. Results Between January 2021 and September 2023, 12 patients underwent reconstruction by Elliot's ﬂap. All ﬂaps settled well. There was no IP joint deformity. Two patients had scar hypertrophy that was managed conservatively. Conclusion Elliot's modification of the Moberg ﬂap is a very useful but underutilized ﬂap for thumb tip injuries that provides like tissue with sensation and with little donor site morbidity. It can be used for thumb tip defects of up to 3 cm. It is possible to incorporate a second V-Y ﬂap in patients for whom additional movement is required for tension-free closure.

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Section: Discussionmentioning

confidence: 99%

Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation

Jayachandiran,

Rajendran,

Mahipathy

et al. 2024

Indian J Plast Surg

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“…However, shortening of the postoperative finger length happens more frequently with DAF than with replantation. Zhou et al 16 reported that fingertip replantation of the thumb using a palmar V-Y advancement flap with a nail bed and bone graft achieved more than 70% length in 78.6% of patients. Hwang et al 3 showed that simultaneous DAF and nail bed graft resulted in 80% of fingertip amputations retaining at least 70% of the length of the uninjured finger.…”

Section: Discussionmentioning

confidence: 99%

Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap using Nail Bed Graft for Fingertip Amputation with Replantation

Kuwahara

Hara

Kurahashi

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Digital artery flap (DAF) with nail bed graft is a simple method to preserve finger length for fingertip amputations. This study compared the clinical and aesthetic outcomes between replantation and DAF. Methods: Patients who underwent replantation or DAF for a single fingertip amputation (Ishikawa subzone II or III) at the authors' hospital from 2013 to 2021 were retrospectively evaluated. The aesthetic and functional outcomes were finger length and nail deformity at the final follow-up, total active motion, grip strength, Semmes-Weinstein monofilament test, Fingertip Injuries Outcome Score, and Hand20 score. Results: Overall, in 74 analyzed cases (40 replantation, 34 DAF), the median operative time and the median length of hospital stay were longer with replantation than with DAF (188 versus 126 minutes; P < 0.01; 15 versus 4 days; P < 0.01). The success rates of replantation and DAF were 82.5% and 94.1%, respectively. The rate of finger shortening with replantation was significantly lower than with DAF (42.5% versus 82.4%; P < 0.01). There were fewer nail deformities with replantation than with DAF (45.0% versus 67.6%; P = 0.06). The proportion of patients who achieved excellent or good Fingertip Injuries Outcome Score and median Hand20 score were not significantly different between the groups (89.5% versus 85.3%, P = 0.61; 8.0 versus 13.5, P = 0.42, respectively). Median postoperative Semmes-Weinstein monofilament test values were similar between the groups (3.61 versus 3.61; P = 0.23). Conclusion:In this retrospective study, compared with replantation, DAF for fingertip amputations achieved equivalent postoperative functional outcomes and shorter intraoperative time and hospital stays, but resulted in inferior cosmetic outcomes.

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“…9 Additionally, thumb fingertip injury is among the most common injuries in the upper limb. 10 The fingertips are also the most important organs for tactile sensation. Therefore, reconstruction of sensation of the thumb fingertip is considered essential by hand surgeons after a thumb fingertip injury.…”

Section: Discussionmentioning

confidence: 99%

Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V–Y flaps for donor site repair

Wang

Zhou

Qiang

et al. 2022

J Orthop Surg (Hong Kong)

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Purpose: To assess the clinical value and feasibility of the dorsoulnar flap of the thumb combined with relay V–Y flaps for reconstruction of the thumb fingertip injuries. Methods: In this retrospective study, we retrospectively reviewed 20 patients (13 men, 7 women; June 2014–June 2016) with thumb fingertip defects who underwent reconstructive procedures with transfer of the dorsoulnar flap of the thumb. The average size of the defects ranged from 1.8 cm × 2.0 cm to 2.0 cm × 3.0 cm, whereas the reconstructed dorsoulnar flap of the thumb ranged in size from 2.0 cm × 2.2 cm to 2.2 cm × 3.0 cm. A V-Y flap was used to repair the donor site at the same time. Sensation within the reconstructed thumb, the aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work (RTW) time were measured. Results: All 40 flaps survived without necrosis. The follow-up period ranged from 6 to 24 months. There were no complications reported. The mean static two-point discrimination values at the reconstructed thumb fingertip and donor site were 8.5 mm (range 8–10 mm) and 12.5 mm (range 12–14 mm), respectively. The average visual analog scores for the aesthetic appearance of the recipient and donor sites were 8.4 (range 8–9.5) and 9.6 (range 9–10), respectively. The average Michigan Hand Outcome Questionnaire score for the reconstructed hand was 9.4 (range 6–16). The average RTW time was 9.8 weeks (range 6–13 weeks). All patients were satisfied with the aesthetic outcome. Conclusion: The dorsoulnar flap of the thumb is an ideal alternative for reconstruction of the thumb fingertip injuries, and a V-Y flap was suitable for repairing the donor site with a reduced incidence of complications.

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Thumb fingertip reconstruction with palmar V–Y flaps combined with bone and nail bed grafts following amputation

Abstract: We believe that the combination of palmar V-Y flap and bone and nail bed grafts provides a distinct advantage over other choices. It improves function when replantation is not an option.

Cited by 14 publications

References 11 publications

Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation

Revisiting Elliot's Modification of Moberg's Flap and Our Improvisation

Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap using Nail Bed Graft for Fingertip Amputation with Replantation

Thumb fingertip injuries reconstruction using a dorsoulnar flap of the thumb combined with relay V–Y flaps for donor site repair

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