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Archives of Orthopaedic and Trauma Surgery

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01-08-2019 | Fingertip Injury | Handsurgery

Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap

Authors: Annika Arsalan-Werner, Natallia Brui, Isabella Mehling, Michael Schlageter, Michael Sauerbier

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2019

Abstract

Introduction

Fingertip injuries are frequent and several surgical strategies exist to reconstruct the amputated part and restore function and appearance. Yet, long-term results are rarely published. The purpose of this study was to examine the long-term clinical outcome of neurovascular island flaps for traumatic fingertip amputation of Allen type III/IV injuries.

Materials and methods

We retrospectively analysed a cohort of patients with traumatic fingertip amputation that underwent reconstruction with a neurovascular island flap from January 2003 to December 2014. No mandatory splinting was applied after surgery. 28 participants (29 fingers) were available for follow-up at mean 8 years after reconstruction. Activities of daily living were measured with the disabilities of the arm, shoulder and hand questionnaire. Grip strength and finger motion were assessed using a Jamar dynamometer and a goniometer. Two-point discrimination and Semmes–Weinstein monofilaments were used to evaluate sensory recovery.

Results

No intraoperative complications occurred and all flaps survived. Mean flap size was 4.7 ± 0.6 cm². Active motion of the fingers was over 95% of the contralateral side at follow-up. Three patients showed mild extension lag of the proximal interphalangeal joint. The grip strength of the affected hand and of each of the affected fingers was over 70% of the contralateral side. In comparison to the contralateral side we did not detect any significant difference for the Semmes–Weinstein monofilament test, but two-point discrimination (5.1 ± 1.7 mm) was significantly impaired. According to the Lim classification 1 of 14 nails with hook nail deformity showed grade 3 breaking of the nail. The DASH score was 16.0. All patients returned to their original occupation and patient satisfaction with the procedure was high.

Conclusions

The risk for disabling flexion contracture seems to be small even without mandatory splinting. Neurovascular island flaps for fingertip amputation of Allen type III/IV injuries are a reliable tool in fingertip reconstruction in the long term.

Sorock GS, Lombardi DA, Hauser RB, Eisen EA, Herrick RF, Mittleman MA (2002) Acute traumatic occupational hand injuries: type, location, and severity. J Occup Environ Med 44(4):345–351CrossRefPubMed

Harenberg PS, Jakubietz RG, Jakubietz MG, Schmidt K, Meffert RH (2012) Reconstruction of the thumb tip using palmar neurovascular flaps. Operative Orthopadie und Traumatologie 24(2):116–121. https://doi.org/10.1007/s00064-011-0081-3 CrossRefPubMed

Katz RD (2013) The anterograde homodigital neurovascular island flap. J Hand Surg Am 38(6):1226–1233. https://doi.org/10.1016/j.jhsa.2013.03.025 CrossRefPubMed

Borman H, Maral T, Tancer M (2000) Fingertip reconstruction using two variations of direct-flow homodigital neurovascular island flaps. Ann Plast Surg 45(1):24–30CrossRefPubMed

Evans DM, Martin DL (1988) Step-advancement island flap for fingertip reconstruction. Br J Plast Surg 41(2):105–111CrossRefPubMed

Lanzetta M, Mastropasqua B, Chollet A, Brisebois N (1995) Versatility of the homodigital triangular neurovascular island flap in fingertip reconstruction. J Hand Surg (Edinburgh, Scotland) 20(6):824–829CrossRef

Kayalar M, Bal E, Toros T, Sugun ST, Ozaksar K, Gurbuz Y (2011) The outcome of direct-flow neurovascular island flaps in pulp defects. Acta orthopaedica et traumatologica turcica 45(3):175–184. https://doi.org/10.3944/aott.2011.2429 CrossRefPubMed

Braga-Silva J, Gehlen D, Bervian F, da Cunha GL, Padoin AV (2009) Randomized prospective study comparing reverse and direct flow island flaps in digital pulp reconstruction of the fingers. Plast Reconstr Surg 124(6):2012–2018. https://doi.org/10.1097/PRS.0b013e3181bcf2b9 CrossRefPubMed

Usami S, Kawahara S, Yamaguchi Y, Hirase T (2015) Homodigital artery flap reconstruction for fingertip amputation: a comparative study of the oblique triangular neurovascular advancement flap and the reverse digital artery island flap. J Hand Surg Eur 40(3):291–297. https://doi.org/10.1177/1753193413515134 CrossRef

10.

Varitimidis SE, Dailiana ZH, Zibis AH, Hantes M, Bargiotas K, Malizos KN (2005) Restoration of function and sensitivity utilizing a homodigital neurovascular island flap after amputation injuries of the fingertip. J Hand Surg (Edinburgh, Scotland) 30(4):338–342. https://doi.org/10.1016/j.jhsb.2005.04.014 CrossRef

11.

Allen MJ (1980) Conservative management of finger tip injuries in adults. Hand 12(3):257–265CrossRefPubMed

12.

Dellon AL (1978) The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system. J Hand Surg Am 3(5):474–481CrossRefPubMed

13.

MacDermid JC (2005) Measurement of health outcomes following tendon and nerve repair. J Hand Ther Off J Am Soc Hand Ther 18(2):297–312. https://doi.org/10.1197/j.jht.2005.02.009 CrossRef

14.

Rosen B, Dahlin LB, Lundborg G (2000) Assessment of functional outcome after nerve repair in a longitudinal cohort. Scand J Plast Reconstr Surg Hand Surg 34(1):71–78CrossRefPubMed

15.

Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabilit 11(3):256–260CrossRef

16.

Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608. https://doi.org/10.1002/(sici)1097-0274(199606)29:6%3c602:aid-ajim4%3e3.0.co;2-l CrossRef

17.

Lim GJ, Yam AK, Lee JY, Lam-Chuan T (2008) The spiral flap for fingertip resurfacing: short-term and long-term results. J Hand Surg Am 33(3):340–347. https://doi.org/10.1016/j.jhsa.2007.12.005 CrossRefPubMed

18.

Krauss EM, Lalonde DH (2014) Secondary healing of fingertip amputations: a review. Hand (New York, NY) 9(3):282–288. https://doi.org/10.1007/s11552-014-9663-5 CrossRef

19.

Champagne L, Hustedt JW, Walker R, Wiebelhaus J, Nystrom NA (2016) Digital tip amputations from the perspective of the nail. Adv Orthop 2016:1967192. https://doi.org/10.1155/2016/1967192 CrossRefPubMedPubMedCentral

20.

Unglaub F, Langer MF, Unglaub JM, Müller LP, Hahn P, Spies CK, Löw S (2018) Defect coverage of fingers and thumb: Indications and treatment. Unfallchirurg 121(4):321–334. https://doi.org/10.1007/s00113-018-0469-8 CrossRefPubMed

21.

Tan HL, Tan DY, Zhao JK (2013) Treatment of thumb soft-tissue defects using a bipedicle island flap of the index finger: anatomical basis and clinical application. Arch Orthop Trauma Surg 133(5):721–728. https://doi.org/10.1007/s00402-013-1704-y CrossRefPubMed

22.

Zhou X, Wang L, Mi J, Xu Y, Rui Y, Xue M, Shen X, Qiang L (2015) Thumb fingertip reconstruction with palmar V-Y flaps combined with bone and nail bed grafts following amputation. Arch Orthop Trauma Surg 135(4):589–594. https://doi.org/10.1007/s00402-015-2163-4 CrossRefPubMed

23.

Kleinert HE, Verdan C (1983) Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am 8(5 Pt 2):794–798CrossRefPubMed

24.

Nakanishi A, Omokawa S, Iida A, Kaji D, Tanaka Y (2015) Predictors of proximal interphalangeal joint flexion contracture after homodigital island flap. J Hand Surg Am 40(11):2155–2159. https://doi.org/10.1016/j.jhsa.2015.08.008 CrossRefPubMed

25.

Sano K, Ozeki S, Kimura K, Hyakusoku H (2008) Relationship between sensory recovery and advancement distance of oblique triangular flap for fingertip reconstruction. J Hand Surg Am 33(7):1088–1092. https://doi.org/10.1016/j.jhsa.2008.02.022 CrossRefPubMed

26.

Mermans JF, Franssen BB, Serroyen J, Van der Hulst RR (2012) Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair. Hand (New York, NY) 7(3):233–241. https://doi.org/10.1007/s11552-012-9433-1 CrossRef

27.

Mennen U, Wiese A (1993) Fingertip injuries management with semi-occlusive dressing. J Hand Surg (Edinburgh, Scotland) 18(4):416–422CrossRef

28.

Peterson SL, Peterson EL, Wheatley MJ (2014) Management of fingertip amputations. J Hand Surg Am 39(10):2093–2101. https://doi.org/10.1016/j.jhsa.2014.04.025 CrossRefPubMed

29.

Quadlbauer S, Pezzei C, Jurkowitsch J, Beer T, Keuchel T, Hausner T, Leixnering M (2017) The semi-occlusive dressing in treating Allen III and IV fingertip injuries as an alternative to local skin flaps. Unfallchirurg 120(11):961–968. https://doi.org/10.1007/s00113-016-0237-6 CrossRefPubMed

30.

Yuan F, McGlinn EP, Giladi AM, Chung KC (2015) A systematic review of outcomes after revision amputation for treatment of traumatic finger amputation. Plast Reconstr Surg 136(1):99–113. https://doi.org/10.1097/prs.0000000000001487 CrossRefPubMedPubMedCentral

31.

Weichman KE, Wilson SC, Samra F, Reavey P, Sharma S, Haddock NT (2013) Treatment and outcomes of fingertip injuries at a large metropolitan public hospital. Plast Reconstr Surg 131(1):107–112. https://doi.org/10.1097/PRS.0b013e3182729ec2 CrossRefPubMed

32.

van den Berg WB, Vergeer RA, van der Sluis CK, Ten Duis HJ, Werker PM (2012) Comparison of three types of treatment modalities on the outcome of fingertip injuries. J Trauma Acute Care Surg 72(6):1681–1687. https://doi.org/10.1097/TA.0b013e318248bc8c CrossRefPubMed

33.

Smith KL, Elliot D (2000) The extended Segmuller flap. Plast Reconstr Surg 105(4):1334–1346PubMed

Title: Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap
Authors: Annika Arsalan-Werner
Natallia Brui
Isabella Mehling
Michael Schlageter
Michael Sauerbier
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Keyword: Fingertip Injury
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 8/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03198-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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