J Reconstr Microsurg 2013; 29(09): 623-630
DOI: 10.1055/s-0033-1356550
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Shi-Ming Feng
1   Department of Hand and Foot Microsurgery, Xuzhou Central Hospital, Affiliated Hospital of Southeast University, Xuzhou, Jiangsu, China
,
Jia-Xiang Gu
2   Department of Hand and Foot Surgery, The Subei People's Hospital of Jiangsu Province, Affiliated Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
,
Hong-Jun Liu
2   Department of Hand and Foot Surgery, The Subei People's Hospital of Jiangsu Province, Affiliated Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
,
Nai-Chen Zhang
2   Department of Hand and Foot Surgery, The Subei People's Hospital of Jiangsu Province, Affiliated Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
,
Jun-Bo Pan
2   Department of Hand and Foot Surgery, The Subei People's Hospital of Jiangsu Province, Affiliated Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
,
Heng Tian
2   Department of Hand and Foot Surgery, The Subei People's Hospital of Jiangsu Province, Affiliated Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
,
Tao Xu
2   Department of Hand and Foot Surgery, The Subei People's Hospital of Jiangsu Province, Affiliated Clinical College of Yangzhou University, Yangzhou, Jiangsu, China
› Author Affiliations
Further Information

Publication History

28 February 2013

25 July 2013

Publication Date:
20 September 2013 (online)

Abstract

This study reports our experience with reconstruction of distal fingertip degloving injuries using a single cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. From January 2009 to October 2011, 18 patients (18 fingers) presented with distal fingertip degloving injuries and were treated with this technique. The mean size of the soft tissue defects was 4.5 cm in length and 2.0 cm in width. The mean size of the cross-finger flaps was 4.7 × 2.1 cm. In the series, all flaps survived completely. No complication was reported, and no further flap debunking procedure was required. At the mean follow-up period of 20.5 months (range, 12–48 mo), the mean static two-point discrimination was 6.3 mm (range, 5–9 mm) of the reconstructed finger pulp. The total range of active motion of the proximal and the distal interphalangeal joints of the donor fingers were 105 and 77.4 degrees, respectively. The cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx is a reliable and simple method in reconstruction of distal degloving injuries of the finger.

 
  • References

  • 1 Deal DN, Barnwell J, Li Z. Soft-tissue coverage of complex dorsal hand and finger defects using the turnover adipofascial flap. J Reconstr Microsurg 2011; 27 (2) 133-138
  • 2 Yabe T, Tsuda T, Hirose S, Ozawa T. Treatment of fingertip amputation: comparison of results between microsurgical replantation and pocket principle. J Reconstr Microsurg 2012; 28 (4) 221-226
  • 3 Gurdin M, Pangman WJ. The repair of surface defects of fingers by trans-digital flaps. Plast Reconstr Surg (1946) 1950; 5 (4) 368-371
  • 4 Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg 1983; 72 (5) 688-697
  • 5 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 (2) 303-309 , e1–e4
  • 6 Lassner F, Becker M, Berger A, Pallua N. Sensory reconstruction of the fingertip using the bilaterally innervated sensory cross-finger flap. Plast Reconstr Surg 2002; 109 (3) 988-993
  • 7 Braga-Silva J, Kuyven CR, Fallopa F, Albertoni W. An anatomical study of the dorsal cutaneous branches of the digital arteries. J Hand Surg [Br] 2002; 27 (6) 577-579
  • 8 Chung KC, Hamill JB, Walters MR, Hayward RA. The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change. Ann Plast Surg 1999; 42 (6) 619-622
  • 9 Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23 (4) 575-587
  • 10 Irwin MS, Gilbert SE, Terenghi G, Smith RW, Green CJ. Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms. J Hand Surg [Br] 1997; 22 (3) 308-316
  • 11 Demiri EC, Dionyssiou DD, Biskiniotis I, Papadimitriou D. Reconstruction of a degloved finger with a heterodigital reverse dorsal digitometacarpal flap. Scand J Plast Reconstr Surg Hand Surg 2007; 41 (1) 42-44
  • 12 Henry M. Degloving combined with structural trauma at the digital level: functional coverage with fascial free flaps. J Reconstr Microsurg 2007; 23 (2) 59-62
  • 13 Jiang Q, Feng M, Jiang Z, Liu J. [Repairing degloving injury of distal phalanx with homodigital bilobed flaps tiled]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26 (7) 806-809
  • 14 Raja Sabapathy S, Venkatramani H, Bharathi R, Jayachandran S. Reconstruction of finger tip amputations with advancement flap and free nail bed graft. J Hand Surg [Br] 2002; 27 (2) 134-138
  • 15 Kojima T, Kinoshita Y, Hirase Y, Endo T, Hayashi H. Extended palmar advancement flap with V-Y closure for finger injuries. Br J Plast Surg 1994; 47 (4) 275-279
  • 16 Yamada N, Ui K, Uchinuma E. The use of a thin abdominal flap in degloving finger injuries. Br J Plast Surg 2001; 54 (5) 434-438
  • 17 Gao W, Yan H, Li Z , et al. The free dorsoradial forearm perforator flap: anatomical study and clinical application in finger reconstruction. Ann Plast Surg 2011; 66 (1) 53-58
  • 18 Takeishi M, Shinoda A, Sugiyama A, Ui K. Innervated reverse dorsal digital island flap for fingertip reconstruction. J Hand Surg Am 2006; 31 (7) 1094-1099
  • 19 Zhang WL, Gao SH, Chen C , et al. [The reverse flap based on two dorsal metacarpal artery for reconstruction of degloved fingertip avulsion]. Zhonghua Zheng Xing Wai Ke Za Zhi 2010; 26 (3) 175-178
  • 20 Wang P, Zhou Z, Dong Q, Jiang B, Zhao J. Reverse second and third dorsal metacarpal artery fasciocutaneous flaps for repair of distal- and middle-segment finger soft tissue defects. J Reconstr Microsurg 2011; 27 (8) 495-502
  • 21 Simsek T, Engin MS, Aslan O, Neimetzade T, Eroglu L. Finger pulp reconstruction with free dorsoulnar artery perforator (DUAP) flap. J Reconstr Microsurg 2011; 27 (9) 543-549
  • 22 Rui Y, Mi J, Shi H, Zhang Z, Yan H. Free great toe wrap-around flap combined with second toe medial flap for reconstruction of completely degloved fingers. Microsurgery 2010; 30 (6) 449-456
  • 23 Lee DC, Kim JS, Ki SH, Roh SY, Yang JW, Chung KC. Partial second toe pulp free flap for fingertip reconstruction. Plast Reconstr Surg 2008; 121 (3) 899-907
  • 24 Kappel DA, Burech JG. The cross-finger flap. An established reconstructive procedure. Hand Clin 1985; 1 (4) 677-683
  • 25 Chen C, Tang P, Zhang X. Sensory reconstruction of a finger pulp defect using a dorsal homodigital island flap. Plast Reconstr Surg 2012; 130 (5) 1077-1086
  • 26 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 (8) 1474-1481