Joint distraction and early mobilization using a new dynamic external finger fixator for the treatment of fracture-dislocations of the proximal interphalangeal joint

Background

Dynamic external fixation is a useful treatment option for unstable fracture-dislocations of the proximal interphalangeal (PIP) joint, because it simultaneously reduces axial pressure load on the joint surface, maintains congruent joint reduction, and permits early joint motion. However, most current devices are large, hindering finger movement, and unstable. To address these problems, we developed a dynamic external finger fixator, named the Micro Ortho Fixator^®. The purpose of this study was to review the results of using the new external finger fixator to treat unstable fracture-dislocations of the PIP joint.

Minimally invasive plate osteosynthesis for humeral shaft fracture: a reproducible technique with the assistance of an external fixator

Background

Minimally invasive plate osteosynthesis (MIPO) has become a popular option for treatment of humeral shaft fractures. However, indirect reduction might risk unpromising results, with mal-alignment/mal-union or nonunion. The purpose of this study was to describe a reproducible MIPO technique that used an external fixator during the procedure as a tool for reduction and maintenance, and to assess the outcomes in patients with humeral shaft fracture.

Methods

Of 31 consecutive cases of humeral shaft fracture in 30 patients, 29 were included in this study. There were seven simple (type A) and 22 comminuted (type B or C) fractures. After the insertion of one Schanz pin on each proximal and distal humerus, a provisional reduction was achieved by connecting the pins with a monolateral external fixator. The MIPO procedure was then performed over the anterior aspect of the humerus. To evaluate the efficacy of the provisional reduction by external fixator, coronal and sagittal alignments were assessed. We also assessed bony and functional results, including complications, from this technique.

Results

There was no case of mal-union >10°, and mean angulation was 1.3° (range 0°–9°) in the coronal plane and 1.2° (range 0°–8°) in the sagittal plane. Twenty-eight of 29 fractures were united, including three delayed unions, with a mean union time of 19.1 weeks (range 12.3–38.4 weeks) and a mean follow-up of 20.8 months (range 13.5–31.0 months). There was one hypertrophic nonunion that healed after fixing with two additional screws. Except one patient with associated injury in the elbow, all patients recovered to pre-injury joint motion. There were two cases of postoperative radial nerve palsy that both recovered completely. We attributed them to manipulation, and not to the Schanz pins or plate fixation.

Conclusions

Surgical treatment of humeral shaft fractures with external fixator-assisted reduction and MIPO resulted in excellent reductions and high union rates.

Level of Evidence

IV     

Osteochondral autograft transplantation for malunited intra-articular fracture of the proximal interphalangeal joint: a case report

Introduction

Malunited intra-articular fracture of the proximal inter-phalangeal (PIP) joint sometimes causes problems, such as range of motion (ROM) limitation in the joint or lack of digital dexterity; however, the treatment method has not yet been established. We report a juvenile case of osteochondral autograft tranplantation to treat a malunited intra-articular fracture of the middle finger.

Case report

A 14-year-old boy was injured at the right middle finger by a baseball impact and underwent conservative treatment. At 5 months after the injury, he complained of continuing pain and restricted ROM. Plain X-ray and CT images showed a bony defect in the articular surface of the PIP joint of the right middle finger. He was diagnosed with malunited intra-articular fracture of the PIP joint and underwent surgical treatment. First, through a palmar incision, a columnar-shaped drill hole was made at the recipient site of osteochondral defect. Then a cylindrical osteochondral plug, 4.5 mm in diameter, harvested from the knee, was inserted into the recipient hole and press-fitted. One year after surgery, the patient has neither pain nor ROM limitation of the finger and the knee joint. MRI showed smooth articular surface of the PIP joint.

Discussion

The benefits of our method include use of articular cartilage as a reconstruction material, availability for a relatively large cartilage defect, and stability of the autograft for the press-fitting method, which enable early mobilization exercise after surgery.     

A systematic review of outcomes of revision amputation treatment for fingertip amputations

Purpose

The purpose of this study was to conduct a systematic review of outcomes of fingertip revision amputation for fingertip amputation injuries in the English-language literature to provide best evidence of functional outcomes.

Methods

A MEDLINE literature search was performed to identify studies that met the following criteria: (1) reported primary data; (2) included at least five cases of primary revision amputation treatment following digit amputation injury; (3) reported finger or thumb amputation at or distal to the distal interphalangeal (DIP) joint or interphalangeal (IP) joint, respectively; (4) presented at least one of the following outcomes: static two-point discrimination (2PD), cold intolerance, arc of motion (AOM) of metacarpophalangeal (MCP) joints, proximal interphalangeal joints (PIP), DIP joints, or return-to-work time.

Results

Thirty-eight studies met the inclusion criteria. Twenty-seven studies reported 2PD, 20 studies reported cold intolerance, eight studies reported AOM, and 18 studies reported return-to-work time after revision amputation of fingertip injuries. The mean 2PD was 5.6 mm. On average, 24 % of patients experienced cold intolerance. AOM at the PIP joint was reported in four studies and averaged 94°. DIP joint AOM was presented in four studies and averaged 66°. Thumb MCP and IP joint AOM was presented in three and four studies, respectively. Mean thumb MCP joint AOM was 54° and that of the IP joint was 71°. The mean return-to-work time was 47 days.

Conclusions

On average, fingertip revision amputation can achieve almost normal sensibility and satisfactory motion and patients can expect to return to work on average approximately 7 weeks after surgery.     

Sekundäre Rekonstruktion des digitalen A2-Ringbands

Objective

Secondary reconstruction of A2 flexor pulley for after closed rupture.

Indications

Persisting impairment of finger function and strength after combined injury of A2 and C1 pulley. Passive free movement of all finger joints.

Contraindications

Fixed flexion contractures of interphalangeal joints after complex finger injuries. Degenerative arthrosis of interphalangeal joints.

Surgical technique

A strip of extensor retinaculum approximately 10 mm in width together with the periosteum from the second floor of the extensor tunnel was used for reconstruction of the A2 pulley. After drilling bilateral burr holes in the palmar aspect of the phalanx at the distal and proximal ends of the A2 pulley, the graft was fixed by the periosteum to the bone of the phalanx, placing the synovial layer innermost.

Postoperative management

Postoperatively, patients in both treatment groups wore a palmar splint which extended from the distal interphalangeal joint to the proximal palmar crease for 4 weeks. The metacarpophalangeal joint and the proximal interphalangeal joint were held in full extension. After removing the splint, physiotherapy was started. Full load-bearing, hard manual work and sport activities were not permitted for 3 months.

Results

Fifteen patients were treated using the extensor retinaculum for reconstruction of the A2 flexor pulley. The mean follow-up time was 48 months. The average range of motion of the PIP joint was 97?%, the average power grip strength 96?%, the finger pinch strength 100?%, and the average circumference 95?% of the uninjured contralateral side. The Buck–Gramcko score showed the following results: 10 excellent, 2 good, and 1 fair.     

Injectable collagenase <Emphasis Type="Italic">Clostridium histolyticum</Emphasis> as a nonsurgical treatment for Dupuytren’s disease

Objective

Nonsurgical treatment of Dupuytren’s disease using collagenase Clostridium histolyticum (CCH).

Indications

Metacarpophalangeal (MP) joint (20–100°) and proximal interphalangeal (PIP) joint (20–80°) contractures.

Contraindications

Pregnancy, previous hypersensitivity to collagenase or excipients, anticoagulant use within 7 days prior to treatment.

Injection technique

CCH injected directly into the Dupuytren’s cord weakening the contracted cord. After injection, the patient returns the following day to allow CCH to lyse the collagen within the cord. An extension force is then applied to the involved finger to disrupt the weakened cord.

Postmanipulation management

Use of extension splint at night, movement instructions during the day.

Results

A total of 120 patients (107 men; 13 women; mean age 62 years, range 30–84 years) were treated. In 49?% the little finger, in 44?% the ring finger, in 4?% the middle finger, and in 3?% the index finger was treated. Full release was achieved in 71?%, partial release in 26?%, and no change in 3?% of patients. The median pretreatment contracture for the MP joint was 37° (range 25–100°) and PIP joint 51° (range 30–97°). At 12 months, the mean contracture for the MP joint was 9° (range 0–25°) and for the PIP joint 21° (range 10–36°). Adverse events observed in 96?% of patients for 3 months . No tendon ruptures, anaphylactic reactions, or nerve or ligament injuries observed.

     

Hemi-hamate arthroplasty for pilon fractures of finger

Background:

Injury following proximal interphalangeal joint fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement.

Materials and Methods:

Hemihamate arthroplasty procedure was used in the reconstruction in five cases with comminuted, impacted fractures of the proximal end of middle phalanx of the finger. Three patients were presented within 2 weeks; one patient came by one month and the other by three months following the injury. All patients presented with posterior subluxation of PIP joint.

Results:

Functional outcome following this procedure in both acute and chronic cases resulted in adequate restoration of joint stability and function.

Conclusions:

Hemihamate arthroplasty is an adjuvant in the treatment of unstable intra-articular pilon fracture involving PIP joint.KEY WORDS: Dorsal dislocation, hemi-hamate arthroplasty, proximal interphalangeal joint, pilon fracture     

Wiederherstellung der Daumenendgelenkbeugung durch Transposition der oberflächlichen Beugesehne des Ringfingers

Objective

Restoration of active thumb flexion at the distal joint.

Indications

Loss of active flexion of the interphalangeal (IP) joint of the thumb if there is a transection of the flexor pollicis longus (FPL) tendon at the tendon channel of the thumb or thenar and direct suture is not possible but the tendon channel is intact, as alternative procedure to a free tendon graft if the transection is proximal to the tendon channel and the muscle of the FPL is contracted/injured or the FPL tendon is unharmed but the FPL muscle is partially or complete paralyzed.

Contraindications

Insufficiency of the FPL tendon channel, impairment of the superficial or deep flexor tendon of the ring finger, limited passive motion of the proximal and distal thumb joints, acute local general infection and non-compliance or incapacity of the patient.

Surgical technique

The surgical technique depends on the necessity of transosseous refixation of the FDS IV at the base of the distal phalanx of the thumb or the possibility of woven sutures through the FPL proximal to the tendon channel. If the tendon channel is intact the distal part of the FPL tendon is shortened to 1 cm, the FDS IV tendon is cut distal to the chiasma of Camper, pulled through the carpal tunnel and moved into the channel of the FPL tendon and fixed transosseously through the base of the distal phalanx of the thumb. If the transection of the FPL tendon is located proximal to the tendon channel and muscle of the FPL is injured, FDS IV tendon will be woven using the Pulvertaft technique through the FPL tendon at the distal forearm.

Postoperative management

Postoperative 6 weeks motion of thumb flexion without resistance in relieved position of the thumb through a thermoplast splint and 6 weeks of functional use of the hand with increasing weight bearing.

Results

In this study 10 patients with FDS IV transposition to reconstruct an isolated rupture of the FPL tendon could be followed for an average of 4.1 years postoperatively. The active range of motion of the IP joint of the thumb averaged 65° (10–100°), 8/10 patients achieved an equal active and passive range of motion of the IP joint of the thumb, in 2 patients some flexion insufficiency remained, 9 patients could reach the fingertip of the small finger with the thumb and 1 patient lacked 3 mm. Contracture of the proximal thumb joint developed in two patients. After removal of the FDS IV tendon two patients developed contracture of the PIP joint of the ring finger. The grip force was reduced to 81?%, lateral grip to 83?% and pinch grip to 77?%. The DASH score averaged 18 (0–31) and 8/10 patients would choose to undergo this surgery again.     

Der Bewegungsfixateur zur frühfunktionellen Behandlung komplexer osteoligamentärer Verletzungen des Ellenbogengelenks

Background

The treatment of complex injuries of the elbow joint by a hinged fixator is a new concept of external transfixation with guided movement in a defined monocentric axis. Biomechanical investigations using cadaver specimens showed that the monocentric guidance ensures additional stability in these unstable osteoligamentous injuries, allows early functional treatment, and can be used in primary but also in revision surgery.

Patients and methods

Between 1997 and 2004, 23 patients with complex fractures of the elbow joint were treated with a hinged monocentric external fixator after open reduction and internal fixation. The early functional treatment started 6.4 days (mean) postoperatively; the average range of motion (ROM) was 58°.

Results

The early functional treatment using a hinged fixator resulted in a mean increase in the range of motion of up to 71° within an average time course of 34.7 days. In 18 patients a significant increase in the ROM was seen; in 4 patients no improvement in the ROM could be achieved. Only one patient showed a decrease in ROM (5°). Follow-up examinations after 10 months revealed a mean ROM of 88°.

Conclusion

In agreement with the literature, our results provide evidence that the use of a hinged monocentric external fixator in combination with early functional therapy results in an increase in the ROM and represents a beneficial device and concept in the treatment of complex injuries of the elbow joint.     

Ball-joint versus single monolateral external fixators for definitive treatment of tibial shaft fractures

Purpose

To compare modular monolateral external fixators with single monolateral external fixators for the treatment of open and complex tibial shaft fractures, to determine the optimal construct for fracture union.

Materials and methods

A total of 223 tibial shaft fractures in 212 patients were treated with a monolateral external fixator from 2005 to 2011; 112 fractures were treated with a modular external fixator with ball-joints (group A), and 111 fractures were treated with a single external fixator without ball-joints (group B). The mean follow-up was 2.9 years. We retrospectively evaluated the operative time for fracture reduction with the external fixator, pain and range of motion of the knee and ankle joints, time to union, rate of malunion, reoperations and revisions of the external fixators, and complications.

Results

The time for fracture reduction was statistically higher in group B; the rate of union was statistically higher in group B; the rate of nonunion was statistically higher in group A; the mean time to union was statistically higher in group A; the rate of reoperations was statistically higher in group A; and the rate of revision of the external fixator was statistically higher in group A. Pain, range of motion of the knee and ankle joints, rates of delayed union, malunion and complications were similar.

Conclusion

Although modular external fixators are associated with faster intraoperative fracture reduction with the external fixator, single external fixators are associated with significantly better rates of union and reoperations; the rates of delayed union, malunion and complications are similar.     

Locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop

Introduction

Tibial fractures with compromised soft tissue envelop may lead to significant complications. The optimal management of these injuries remains controversial. Recently, locking plate used as a definitive external fixator is attractive because it not only minimizes trauma to the soft tissues, but also overcomes the shortcomings of standard external fixators. The objective of this study was to evaluate the outcome of using locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop.

Patients and methods

A prospective series of 12 consecutive tibial fractures with compromised soft tissue envelop were treated using locking plate as a definitive external fixator. Of these patients, six were Gustilo and Anderson type IIIA, three were type II and three were closed fractures (AO/ASIF soft tissue injury classification IC4: 2, IC5: 1). Time to union, nonunion, malunion, leg shortening, range of motion and function for the knee and ankle, deep infection, pin tract infections were evaluated.

Results

The mean bone healing time was 37.8 weeks (range 20–56 weeks). Eventually, all of the fractures united. Most of the fractures healed in acceptable positions. There were no cases of deep infection. Pin tract infection was seen in 1 (8.3 %) patient, no loosening or failure of the external fixator was seen. At the most recent follow-up, the mean range of motion at the knee was extension 0° to flexion 135°, and the mean ankle range of motion was dorsi flexion 12° to plantar flexion 32°. All patients had excellent or good functional results and were fully weight bearing with a well-healed tibia at the final follow-up.

Conclusion

The locking plate used as a definitive external fixator provided a high rate of union. The patients experienced a comfortable clinical course, excellent knee and ankle joint motion, satisfactory functional results and an acceptable complication rate. However, the stiffness of external locked plating is not clear, therefore, clinical recommendation on its practical use to reduce the risk of implant failure still need to be determined.     

Primäre Alloarthroplastik des frakturierten Ellenbogens beim hochbetagten Patienten

Aim of study

Inadequate treatment of distal intra-articular fractures of the humerus results in painful restriction of movement or malarticulation. Especially in geriatric patients with osteoporosis, stable osteosynthesis can be difficult. Primary total endoprosthetic replacement of the cubital joint could offer an alternative.

Material and methods

In 12 patients with a distal intra-articular fracture of the humerus a cemented semi-constrained Coonrad-Morrey prosthesis was implanted. Patient were followed-up after an average of 13 months and assessed according to the Mayo score.

Results

In 6 patients additional computerized tomography was carried out. Minimally invasive Kirschner wire osteosynthesis resulted in immediate postoperative loss of correction due to osteoporosis. As with the external distraction-compression apparatus the ulnar pinholes can form a predetermined breaking point and fixation in a long-arm cast is recommended. The mean Mayo score was 90.5 points and mean range of motion in extension/flexion was 84.5°.

Conclusion

In elderly patients primary endoprosthetic treatment of a distal intra-articular fracture of the humerus with a semi-constrained cemented prosthesis may offer an alternative to osteosynthesis thus enabling creation of a mobile, painless and stable cubital joint.     

Die Behandlung bakterieller Infektionen an den Interphalangealgelenken der Hand

Objective

Radical debridement of joint infection, prevention of further infection-related tissue destruction.

Indications

Septic arthritis of interphalangeal joints in the thumb and fingers.

Contraindications

Extensive soft tissue defects. Severe impairment of blood circulation, finger gangrene. Noncompliance for immobilization or for treatment with external fixator.

Surgical technique

Arthrotomy and irrigation with isotonic solution. Radical tissue debridement. Joint preservation possible only in the absence of infection-related macroscopic cartilage damage. Otherwise, resection of the articular surfaces and secondary arthrodesis. Insertion of antibiotic-coated devices. Temporary immobilization with external fixator.

Postoperative management

Inpatient postoperative treatment with 5-day intravenous administration of a second-generation cephalosporine (e.g., Cefuroxim?) followed by 7?C10?days oral application. Adaptation of antibiotics according to antibiogram results. In joint-preserving procedures, radiographs and fixator removal after 4?weeks, active joint mobilization. If joint surfaces were resected, removal of fixator after 6?weeks; arthrodesis under 3-day intravenous broad-band antibiotic prophylaxis. Splint immobilization until consolidation (6?C8?weeks).

Results

In 10 of 40?patients, the infected joint could be preserved. All infections healed. After an average duration of therapy of 6 (3?C11)?weeks, 4?individuals were free of complaints, and 6?patients had minor symptoms. Overall range of motion in the affected finger was reduced by 25?C50° in 5?patients. All patients could return to work after 6.6 (4?C11)?weeks. A total of 30?patients were treated with joint resection and external fixator. After 5.6 (4?C8)?weeks, arthrodesis was performed, leading to consolidation in 29?patients. One patient underwent amputation after 4?months due to delayed gangrene. Treatment duration was 15.7 (7?C25)?weeks. Eight patients reported no complaints, 14 suffered mild symptoms, 5 had moderate, and 3 had severe symptoms in daily life. In 15?cases, range of motion was diminished by 10?C80° in the remaining joints of the affected finger. Patients could return to work after 16.2 (6?C28)?weeks.     

Management of open infected comminuted tibial fractures using Ilizarov concept

Background

Bone loss is very common in high energy trauma. It could be treated either by amputation and prosthesis or by reconstruction of both bony and soft tissue structures. The choice of treatment in a given case must be based on the assessment of the local and general condition of the patient such as regional neurovascular supply, and the residual articular and muscular function. Reconstruction may require bone grafts, tibiofibular synostosis, free microvascular soft tissue or bone transplants. The use of Ilizarov concept gives another option for treatment of bone defects. In this study, infected tibial fractures were treated using Ilizarov concept.

Patients and methods

Twenty-eight patients (20 males and 8 females) with open comminuted infected fracture of the tibia were included. After debridement, all cases had variable amount of bone defects and were treated using Ilizarov technique. Follow-up was for at least 1 year. Filling of the bone defect was achieved either by compression–distraction method in 13 cases (group I) or by means of bone transport in the other 15 cases (group II).

Results

The results were judged as excellent in 16 patients, good in 9 and fair in 2, while one patient was of poor result. Type of fracture, age of the patient and sex had no statistically significant relation with the final end results. Furthermore, there was no significant difference between the two groups. The average external fixator index was 45 days/cm (range from 35 to 70 days/cm). The mean external fixator index was less in group I.

Conclusion

In the management of infected comminuted tibial shaft fractures, bone transport is indicated for the treatment of major bone loss, whereas compression–distraction is suitable only for treating less extensive bone gaps.     

Laterodorsaler Transpositionslappen zum Verschluss eines Weichteildefekts am palmaren Kleinfingergrundglied nach Auflösung einer Dupuytren-Rezidivbeugekontraktur

Objective

Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren’s contracture.

Indications

A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren’s contracture.

Contraindications

Scars at the lateral–dorsal portion of the proximal phalanx (e.g., after burns).

Surgical technique

Modified incision after Bruner (“mini-Bruner”). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral–dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant.

Postoperative management

Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy.

Results

Between 2002 and 2007, a total of 32 lateral–dorsal transposition flaps in 30 patients with recurrent Dupuytren’s disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.

     

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Background

Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces.

Questions/purposes

We determined whether (1) an anterior external fixator with a second anterior articulation (X-frame) would provide posterior pelvic compression and (2) full pin insertion would deliver higher posterior compressive forces than half pin insertion.

Methods

We simulated AP compression Type III instability with plastic pelvis models and tested the following conditions: (1) single-pin supraacetabular external fixator (SAEF) using half pin insertion (60 mm); (2) SAEF using full pin insertion (120 mm); (3) modified fixator with X-frame using half pin insertion; (4) modified fixator using full pin insertion; and (5) C-clamp. Standardized fracture compression in the anterior and posterior compartment was performed as in previous studies by Gardner. A force-sensitive sensor was placed in the symphysis and posterior pelvic ring before fracture reduction and the fractures were reduced. The symphyseal and sacroiliac compression loads of each application were measured.

Results

The SAEF exerted mean compressions of 13 N and 14 N to the posterior pelvic ring using half and full pin insertions, respectively. The modified fixator had mean posterior compressions of 174 N and 222 N with half and full pin insertions, respectively. C-clamp application exerted a mean posterior load of 407 N.

Conclusions

Posterior compression on the pelvis was improved using an X-frame as an anterior fixation device in a synthetic pelvic fracture model.

Clinical Relevance

This additive device may improve the initial anterior and posterior stability in the acute management of unstable and life-threatening pelvic ring injuries.     

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit

Objective

Providing soft tissue coverage for finger neurocutaneous defects presents aesthetic and sensory challenges. A common source for reconstruction of soft tissue defects of the fingers is the same finger. However, when the donor areas are damaged by concomitant injuries, this option is not available. The present study aims to reconstruct finger neurocutaneous defects using a sensory reverse dorsal digital artery flap from the neighboring digit and to evaluate the efficacy of this technique.

Methods

The study included 16 patients, with an average age of 34.9 years (range, 20–53 years) at the time of surgery, from May 2010 to June 2013. The sensory reverse dorsal digital artery flap was used in all 16 patients, who had a combination of soft tissue and digital nerve defects. The mean size of the soft tissue defects was 3.1 cm × 2.0 cm, and the mean flap size was 3.3 cm × 2.2 cm. The length of the nerve defects ranged from 1.3 to 2.5 cm (mean, 2.0 cm), which were reconstructed with dorsal branches of the proper digital nerve transfer. The active motion of the fingers (injured and donor) and the flap sensibility (static two‐point discrimination) were measured. The appearance and functional recovery of the injured finger and the donor site were assessed using the Michigan Hand Outcomes Questionnaire.

Results

All flaps survived completely. No complications were reported, and no further flap debulking procedure was required. At the mean follow‐up period of 24 months (range, 18–30 months), the mean static two‐point discrimination was 6.5 mm (range, 5–10 mm) of the reconstructed area; the mean ranges of motions of the injured finger and the opposite finger at the proximal interphalangeal and distal interphalangeal joints were 102.2° and 103.5°, and 70.3° and 76.5°, respectively. The average ranges of motions of the metacarpophalangeal and proximal interphalangeal joints of the donor fingers were 90° and 103.4°, respectively. Based on the Michigan Hand Outcomes Questionnaire, 10 patients were strongly satisfied and 6 were satisfied with the functional recovery of the injured finger; however, 13 patients were strongly satisfied and 3 were satisfied with the appearance of the injured finger.

Conclusion

The sensory reverse dorsal digital artery flap from the neighboring digit, based on the dorsal branch of the digital artery, is an effective and additional option for finger neurocutaneous defect reconstruction when use of the local and regional flaps is not feasible.