Fingertip Reconstruction with the Laterally Based Thenar Flap: Indications and Long-Term Functional Results

The thenar flap is a time-tested method of fingertip reconstruction, but functional outcome data are scarce in the literature. The purpose of this study was to analyze the long-term function following fingertip reconstruction with a laterally based thenar flap and to compare these results with other established methods. Nineteen patients underwent a thenar flap between 2001 and 2004. Patients ranged in age from 3 to 48 years. The mean angle of proximal interphalangeal immobilization was 66° (range 30–85°) and was greater for radial digits. Time to division ranged from 11 to 15 days. Seventeen patients underwent follow-up evaluation of range of motion, two-point discrimination, and sensory threshold (Semmes-Weinstein). A questionnaire measured patient satisfaction in three areas: sensibility, function, and appearance. The mean follow-up was 20 months. Reconstructive goals were met in all cases. The mean metacarpalphalangeal and proximal interphalangeal motion in the reconstructed fingers was not significantly reduced, compared to the unaffected side. The distal interphalangeal motion was 42°, compared to 55° in the contralateral side (p < 0.01). The mean static two-point discrimination in the flap was 6.8 mm, compared to 3.8 mm in the contralateral side. Fourteen of 17 patients exhibited monofilament thresholds of 33.1 g/mm² or less. There were no hypertrophic or tender donor scars. This study does not support the contention that thenar flaps are associated with problematic donor scars and flexion contractures, even for adults or ulnar digits. Sensory recovery compared favorably to published results of cross-finger and homodigital flaps. When sound technical principles are followed, excellent outcomes can be expected.Presented at the 2006 Meeting of the American Association for Hand Surgery, Tuscon, AZ.     

Eponychial Flap: A Simpler Way to Achieve Better Aesthetic Outcome in a Fingertip Amputation

Background  There are numerous flaps described for the treatment of fingertip amputation. Shortened nail length resulting from amputation is an ignored area. Eponychial flap is a simple procedure that helps to lengthen the nail plate and correct this deformity. Methods  This case–control study was conducted between April 2016 and June 2020 aimed at comparing the outcome of nail defects in a fingertip amputation treated with eponychial flap and those treated without an eponychial flap. Results  Among 165 patients treated for fingertip injury, 78 were treated with eponychial flap (group A) and 87 without eponychial flap (group B). In group A, the nail length was 72.54% (standard deviation [SD]: 14.4) and the nail plate area was 74.35% (SD: 13.96) compared with the contralateral uninjured nail. These results were significantly better ( p  = 0.000) compared with group B where the values were 36.49 (SD: 8.45) and 35.8% (SD: 8.4), respectively. The aesthetic outcome score was also significantly higher in group A patients ( p  = 0.002). The patient satisfaction was superior in group A compared with group B. Conclusion  The eponychial flap is a simple and reliable technique that can be used to restore the visible nail length in traumatic fingertip defects. Compared with fingers treated without nail lengthening with eponychial flap gives excellent aesthetic results.     

Lateral Calcaneal Artery Adipofascial Flap for Reconstruction of the Posterior Heel of the Foot

Background

Soft tissue defects of the posterior heel of the foot present difficult reconstructive problems. This paper reports the authors'' early experience of five patients treated with a lateral calcaneal artery adipofascial flap.

Methods

Between 2003 and 2007, five patients (3 males and 2 females) with soft-tissue defects over the posterior heel underwent a reconstruction using a lateral calcaneal artery adipofascial flap and a full-thickness skin graft. The flap sizes ranged from 3.5 × 2.5 cm to 5.5 × 4.0 cm.

Results

All five flaps survived completely with no subsequent breakdown of the grafted skin, even after regularly wearing normal shoes. The adipofascial flap donor sites were closed primarily in all patients.

Conclusions

Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot.     

Study of Yang's Onion Flap Technique for Release of Scarred Eponychium and Nail Fold Reconstruction in Burn Patients

Background  Abnormalities of fingernail growth and appearance are among the most common deformities encountered after burn injury to the hand. Various techniques used for resurfacing defects include incision of the scarred eponychium and advancement of the distal segment, flap reconstruction-distally, and proximally based transposition/advancement flaps, composite graft techniques, microvascular transfer. In the present study, we used an onion flap to release scarred eponychium and nail fold reconstruction in a single stage without using soft tissue from another area. Materials and methods  Forty-four burnt fingers were operated using Yang''s onion flap technique. Patients were assessed for flap necrosis, hematoma and infection in the early postoperative period and for donor site scar, nail appearance, and symptomatic relief in a follow-up for at least 4 months. Results  The flap was successfully performed on all fingers. Only two fingers had flap necrosis. There was no incidence of hematoma or infection. The donor site scar and nail plate appearance improved and was acceptable to most patients after surgery. There was also significant relief in daily activities in 19 out of 28 symptomatic patients. Conclusion  Yang''s flap to correct nail deformities in burn patients is feasible in Indian scenario. It is associated with a low complication rate and improved nail appearance. There is also significant symptomatic relief in performing daily activities after surgery.     

The spiral flap for fingertip resurfacing: short-term and long-term results

PURPOSE: We describe a homodigital neurovascular island flap for reconstructing large pulp defects of the fingertips and review the short-term and long-term appearance and function of the reconstructed fingertips. METHODS: The spiral flap is a homodigital neurovascular island flap with a unique spiral advancement and transposition design that allows pulp reconstruction using sensate glabrous skin while restricting donor morbidity to the injured digit. Thirty-two fingertips were resurfaced using this flap. All had large pulp defects averaging 1.2 cm wide x 2.0 cm long (1.0-2.0 cm x 1.5-2.5 cm). Short-term results (<18 months) for all patients at a minimum of 6 months and long-term results (>5 years) for 10 patients with a mean follow-up of 13 years were reviewed. Objective outcome measures included static 2-point discrimination, degree of nail deformity (beaking), total active motion, and hypersensitivity or cold intolerance. Subjective outcome measures included patient satisfaction with function and aesthetics, using a visual analog scale. RESULTS: All flaps achieved primary healing with no complications. There was initially mild extension deficit in the proximal interphalangeal and distal interphalangeal joints, which improved to full range of motion in the long term. Sensory recovery was excellent, with an average 2-point discrimination of 5 mm initially, improving to 4 mm in the long term. Nail beaking was minimal initially but increased significantly in the long term. These results may be explained by soft tissue remodeling. All patients on long-term follow-up were highly satisfied with both aesthetic and functional outcome. There was no hypersensitivity or cold intolerance at either the short-term or long-term follow-up assessments. CONCLUSIONS: The spiral advancement-transposition flap is suitable for resurfacing large pulp defects with excellent short-term and long-term functional and aesthetic results and high patient satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Reconstruction of the Umbilicus Using a Reverse Fan-Shaped Flap

The goal of the reconstruction for umbilical absence is to obtain a natural three-dimensional appearance of the umbilicus with minimal operative scarring. This paper presents two cases of umbilical reconstruction using a reverse fan-shaped flap. In both cases, the umbilicus was lost during surgical procedures on the abdominal wall when the patients were newborns. We performed this technique in both cases. This technique is simple and safe. With this technique, a permanent umbilical depth and ring can be obtained without any complications.     

Nipple Reconstruction Using the Fleur-de-lis Flap Technique

The authors propose a simple and reliable technique for nipple reconstruction characterized by minimal loss in vertical projection.     

Thirteen-Year Follow-Up Reverse Sural Artery Flap for Plantar Calcaneal Wound: A Case Report

Reconstruction of soft tissue defects in the lower leg and foot after traumatic injury is a challenging problem owing to lack of locally reliable flaps. The traditional options for wound coverage often do not provide feasible or adequate treatment for many of these wounds. The lack of skin laxity in the lower leg and foot often make local flaps unavailable. Split-thickness skin grafts will not be robust enough. Free tissue flaps have a litany of potential complications and guaranteed comorbidities. The present case reinforces that appropriately selected patients with significant open bony and soft tissue trauma to the foot and ankle can be treated with a reverse sural artery fasciocutaneous flap. The reverse sural artery flap allows for full-thickness skin coverage with its own blood supply, maximizing the healing potential and should be considered a viable first option for soft tissue coverage.     

Linguiform rotation flap for amputations of the fingertip

The aim of all treatments for fingertip amputation is to reconstruct the defects and meet the patient's needs. Sometimes an easy and versatile one-step procedure is needed. Between July 2005 and June 2006, 23 patients with amputated fingertips were treated with the linguiform rotation flap. It is a rotation advancement flap with the pedicle and a skin bridge usually on the volar side near the margin of the stump, and is based on one of the neurovascular bundles, the dorsal branches of the palmar digital arteries, the dorsal digital arteries, and the network among them. The follow-up period was 3 months to 1.5 years (mean 7.5 months), with relatively good results. The linguiform flap can be used for amputations at any level from the nailfold to the proximal interphalangeal joint to cover the exposed bone and tendon. The technique is simple and safe, and provides good protective padding. It is a good alternative for the reconstruction of fingertip amputations, particularly transverse, dorsal, and lateral oblique ones.