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CC BY-NC-ND 4.0 · Indian J Plast Surg 2023; 56(03): 201-207
DOI: 10.1055/s-0042-1760092
Systematic Review

Donor Finger Morbidity in Cross-Finger Flap: A Systematic Review and Meta-Analysis

Sourabh Shankar Chakraborty 
1   Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Kalyani, Nadia, West Bengal, India
,
Ranjit Kumar Sahu 
2   Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Sudeshna Acharya 
3   Department of Trauma & Emergency, Burdwan Medical College, Bardhaman
,
Akhil Dhanesh Goel 
4   Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
,
Manojit Midya 
5   Plastic & Reconstructive Surgery Department, Government Medical College, Kota, Rajasthan, India
,
Suresh Kotu 
6   Department of Burns and Plastic Surgery, GSL Medical College, Rajahmundry, Andhra Pradesh, India
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Abstract

Background The morbidity of donor finger in a cross-finger flap has not received as much importance as the outcomes of the flap itself. The sensory, functional, and aesthetic morbidity of donor fingers, reported by various authors, are often contradictory to each other. In this study, objective parameters for the sensory recovery, stiffness, cold intolerance, cosmetic outcome, and other complications in the donor fingers, reported in the previous studies, are systematically evaluated.

Methods This systematic review is reported using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol and was registered with the International prospective register of systematic reviews (PROSPERO registration no. CRD42020213721). Literature search was done using “cross-finger,” “heterodigital,” “donor finger,” and “transdigital” words. Data regarding demography, patients' number and age, follow-up duration and outcomes of donor finger, including 2-point discrimination, range of motion (ROM), cold intolerance, questionnaires, etc. were extracted from included studies. Meta-analysis was performed using MetaXL and risk of bias was evaluated using Cochrane risk of bias tool.

Results Out of the total 16 included studies, 279 patients were objectively evaluated for donor finger morbidity. Middle finger was most frequently used as donor. Static two-point discrimination seemed to be impaired in donor finger in comparison to contralateral finger. Meta-analysis of ROM suggested that statistically there is no significant difference in ROM of interphalangeal joints in donor and control fingers (pooled weighted mean difference: −12.10; 95% confidence interval: −28.59, 4.39; I2 = 81%, n = 6 studies). One-third of donor fingers had cold intolerance.

Conclusion There is no significant effect on ROM of donor finger. However, the impairment that seems to be in sensory recovery and aesthetic outcomes needs to be further evaluated objectively.

Keywords

cross-finger flap - donor finger - morbidity - systematic review

Statement of Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.


Level of Evidence

Level of evidence is III.


Supplementary Material



Publication History

Article published online:
07 February 2023

© 2023. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Gurdin M, Pangman WJ. The repair of surface defects of fingers by trans-digital flaps. Plast Reconstr Surg (1946) 1950; 5 (04) 368-371
    CrossrefPubMedGoogle Scholar
  • 2 Nishikawa H, Smith PJ. The recovery of sensation and function after cross-finger flaps for fingertip injury. J Hand Surg [Br] 1992; 17 (01) 102-107
    CrossrefPubMedGoogle Scholar
  • 3 Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery. Ann Plast Surg 2008; 61 (04) 385-391
    CrossrefPubMedGoogle Scholar
  • 4 Rabarin F, Saint Cast Y, Jeudy J. et al. Cross-finger flap for reconstruction of fingertip amputations: long-term results. Orthop Traumatol Surg Res 2016; 102 (4, Suppl): S225-S228
    CrossrefPubMedGoogle Scholar
  • 5 Sturman MJ, Duran RJ. Late results of finger-tip injuries. J Bone Joint Surg Am 1963; 45: 289-298
    CrossrefGoogle Scholar
  • 6 Ekinci Y, Gürbüz K. Is the cross-finger flap a good option at the extensor zone defect?. Jt Dis Relat Surg 2020; 31 (02) 267-272
    PubMedGoogle Scholar
  • 7 Paterson P, Titley OG, Nancarrow JD. Donor finger morbidity in cross-finger flaps. Injury 2000; 31 (04) 215-218
    CrossrefPubMedGoogle Scholar
  • 8 Koch H, Kielnhofer A, Hubmer M, Scharnagl E. Donor site morbidity in cross-finger flaps. Br J Plast Surg 2005; 58 (08) 1131-1135
    CrossrefPubMedGoogle Scholar
  • 9 Erken HY, Akmaz I, Takka S, Kiral A. Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger. J Hand Surg Eur Vol 2015; 40 (04) 392-400
    CrossrefPubMedGoogle Scholar
  • 10 Wang B, Zhang X, Jiang W, Ma T, Li H, Wang H. Reconstruction of distally degloved fingers with a cross-finger flap and a composite-free flap from the dorsum of the second toe. J Hand Surg Am 2012; 37 (02) 303-309 , 309.e1–309.e4
    CrossrefPubMedGoogle Scholar
  • 11 Feng SM, Gu JX, Liu HJ. et al. Treatment of distal fingertip degloving injuries using a cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. J Reconstr Microsurg 2013; 29 (09) 623-630
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Chen C, Tang P, Zhang L, Wang B. Treatment of fingertip degloving injury using the bilaterally innervated sensory cross-finger flap. Ann Plast Surg 2014; 73 (06) 645-651
    CrossrefPubMedGoogle Scholar
  • 13 Shao X, Chen C, Zhang X, Yu Y, Ren D, Lu L. Coverage of fingertip defect using a dorsal island pedicle flap including both dorsal digital nerves. J Hand Surg Am 2009; 34 (08) 1474-1481
    CrossrefPubMedGoogle Scholar
  • 14 Lee JYL, Teoh LC, Seah VWT. Extending the reach of the heterodigital arterialized flap by cross-finger transfer. Plast Reconstr Surg 2006; 117 (07) 2320-2328
    CrossrefPubMedGoogle Scholar
  • 15 Chitta M, Malathi L, Joseph A. Cross-finger flap to the thumb: quest for an alternate donor. Indian J Plast Surg 2020; 53 (02) 287-292
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Patil RK, Chavre S. Distally based cross-finger flaps for amputation stumps in avulsion amputations. Indian J Plast Surg 2012; 45 (03) 504-511
    CrossrefPubMedGoogle Scholar
  • 17 Zhao J, Abdullah S, Li WJ, Appukuttan A, Tien HY. A novel solution for venous congestion following digital replantation: a proximally based cross-finger flap. J Hand Surg Am 2011; 36 (07) 1224-1230
    CrossrefPubMedGoogle Scholar
  • 18 Chen C, Tang P, Zhang L. Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap. J Plast Reconstr Aesthet Surg 2015; 68 (07) 990-994
    CrossrefPubMedGoogle Scholar
  • 19 Kim DH, Seo KB, Lee SH, Lee HJ, Kang HJ. Reverse digital artery cross-finger flap for reconstruction of failed finger replantation. J Orthop Surg (Hong Kong) 2019; 27 (01) 2309499018816773
    Google Scholar
  • 20 Al-Qattan MM. Time of return back to work and complications following cross-finger flaps in industrial workers: comparison between immediate post operative mobilization versus immobilization until flap division. Int J Surg Case Rep 2018; 42: 70-74
    CrossrefPubMedGoogle Scholar