Vascularized tendon incorporated in reverse homodigital and heterodigital island flaps for the reconstruction of dorsal digital defects

Rahmanian-Schwarz, Afshin; Schiefer, Jennifer Lynn; Amr, Amro; Schaller, Hans-Eberhard; Hirt, Bernhard

doi:10.1002/micr.20973

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…First, it is only suitable for long tendon defects in zone 6 with or without zone 7 defects. Extensor defects in zone 8 are easily reconstructed by direct tendon transfers, whereas extensor tendon defects in zones 1 to 5 are best done by local tendon flaps or composite free flaps from the toes (Ahmad and Pickford, 2009;Kochevar et al, 2009;Rahmanian-Schwarz et al, 2012). Second, the most common cause of extensor tendon defects on the dorsum of the hand is a friction injury from car or industrial accidents (Al-Qattan et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: indications, technique and results

Al‐Qattan

2013

J Hand Surg Eur Vol

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Over a 20-year period, six patients (19 tendons) underwent two-staged extensor tendon reconstruction using silicone rods followed by palmaris longus tendon grafts sutured proximally to the divided flexor carpi radialis tendon. All patients were young men (mean age, 22 years) who sustained the injury in car accidents. The soft tissue loss from the dorsum of the hand was associated with extensor tendon loss over the entire zone 6 with or without loss in zone 7. Primary soft tissue coverage was done elsewhere, and patients presented for secondary tendon reconstruction. All patients had supple metacarpophalangeal joints before reconstruction. After the two-staged tendon reconstruction, full or near-full active flexion at the metacarpophalangeal joints was obtained in all patients. However, minor extension lags (10°-15°) at the metacarpophalangeal joints were seen in 15 out of 19 reconstructed fingers.

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Section: Discussionmentioning

confidence: 99%

Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: indications, technique and results

Al‐Qattan

2013

J Hand Surg Eur Vol

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“…[ 26 ] To prevent flap loss from venous congestion, it is recommended to preserve approximately 3-4 mm of soft tissue around the pedicle during dissectio. [ 27 ] The absence of torsion is an advantage of the anterograde flow spiral flap technique for inset step.…”

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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“…A local flap is intended to cover the open areas of a finger's vital tissues, such as the tendons, nerves, and bones, but the traditional local flaps commonly used for single finger injuries may not be an option. These convenient flaps include direct‐flow homodigital neurovascular flaps; reverse‐flow, homodigital, dorsal, proximal phalanx skin flaps; and homo/heterodigital middle phalanx island flaps . Unfortunately, often in multi‐finger injuries, using any of the aforementioned flaps is not possible because of damaged donor areas.…”

Section: Discussionmentioning

confidence: 99%

“…These convenient flaps include direct-flow homodigital neurovascular flaps; reverse-flow, homodigital, dorsal, proximal phalanx skin flaps; and homo/heterodigital middle phalanx island flaps. 14,23 Unfortunately, often in multi-finger injuries, using any of the aforementioned flaps is not possible because of damaged donor areas. The defects with the dimensions and location that require venous flap coverage are also generally larger than the classic limits for these flaps.…”

Section: Discussionmentioning

confidence: 99%

Syndactylizing arterialized venous flaps for multiple finger injuries

Kayalar¹,

Küçük

Sügün³

et al. 2014

Microsurgery

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Multiple soft tissue finger defects in different shapes and locations are usually difficult to manage. Such defects commonly involve tendons and bones. Palmar soft tissue defects may also lead to vascular compromise. In this retrospective report, we report the results of seven patients with multiple soft tissue finger defects that were covered by syndactylizing arterialized venous flaps. Six of the patients suffered hot-pressing machine and crushing injuries, one patient had a rolling belt injury. All patients presented with soft tissue defects on palmar or dorsal sides involving at least two digits. The palmar forearm was donor site for all patients. At least one afferent artery and two efferent veins were selected for the anastomosis. Lengths of afferent and efferent veins were long enough to perform healthy anastomosis outside the injury zone. The afferent vessels were anastamosed to the digital arteries with the largest possible diameter or to the common digital arteries to maximize flow. The efferent veins were anastamosed to dorsal veins. Separations of the digits were performed after three weeks by longitudinal incisions. The mean follow-up period was 12 months. None of our patients suffered a flap loss. Syndactylizing arterialized venous flaps may be used for composite or single tissue reconstruction for multiple finger defects with satisfactory cosmetic and functional outcomes.

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Vascularized tendon incorporated in reverse homodigital and heterodigital island flaps for the reconstruction of dorsal digital defects

Abstract: The vascularized tendon incorporated in reverse island flaps provides a sufficient method to restore function of the DIP joint after complex injury and prevents finger deformity, arthrodesis, or amputation.

Cited by 8 publications

References 19 publications

Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: indications, technique and results

Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: indications, technique and results

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

Syndactylizing arterialized venous flaps for multiple finger injuries

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