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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.17

ISSN Imprimir: 0896-2960
ISSN On-line: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v20.i2.10
pages 89-98

Digital Artery Island Flap Reconstruction for Fingertip Amputation−Personal Review

Shohei Omokawa
Department of Orthopedics, Ishinkai-Yao General Hospital, Yao-city, Japan
Yasuhito Tanaka
Department of Orthopedics, Nara Medical University, Kashihara-city, Japan

RESUMO

This study reviews our experience of 174 patients with volar/lateral oblique fingertip amputations who underwent digital artery island flap reconstruction. In 59 patients with thumb amputation, 41 flaps were used in an orthograde-flow direction (20 neurovascular island flaps from the long finger, 14 volar advancement flaps, 2 oblique triangular flaps, and 5 neurovascular “kite” flaps), and 18 flaps in a retrograde-flow direction (10 Brunelli's dorsal thumb flaps and 8 radial thenar flaps). In the 115 patients with digital amputation, 77 reverse digital artery island flaps and 38 orthograde-flow direction flaps (36 oblique triangular flaps and 2 neurovascular island flaps) were used. Donor sites of the 77 reverse digital artery flaps included the palmolateral aspect of the proximal phalanx in 52, midpalm in 15, and the hypothenar area in 10. Complete survival was shown by 170 flaps, while 4 resulted in partial/complete necrosis due to infection or venous congestion. Postoperative complications occurred in 22 patients as deep infections in 2, flexion contractures (> 20 degrees) of the PIP joint in 12, and cold intolerance in 10. Additional procedures were conducted in 32 patients, including 8 z-plasties, 14 full-thickness skin grafts, 10 nail plasties, and 4 bone resections. Painless and stable fingertips are expected to be reconstructed if there is adequate flap selection and, depending on the size and location of the defect, with reasonable cosmetic and functional results, especially for patients with volar/lateral oblique fingertip amputation in which the germinal matrix of the nail remains intact.


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