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.
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References
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):345–351
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
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
Borman H, Maral T, Tancer M (2000) Fingertip reconstruction using two variations of direct-flow homodigital neurovascular island flaps. Ann Plast Surg 45(1):24–30
Evans DM, Martin DL (1988) Step-advancement island flap for fingertip reconstruction. Br J Plast Surg 41(2):105–111
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):824–829
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
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
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
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
Allen MJ (1980) Conservative management of finger tip injuries in adults. Hand 12(3):257–265
Dellon AL (1978) The moving two-point discrimination test: clinical evaluation of the quickly adapting fiber/receptor system. J Hand Surg Am 3(5):474–481
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
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):71–78
Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabilit 11(3):256–260
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
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
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
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
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
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
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
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):794–798
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
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
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
Mennen U, Wiese A (1993) Fingertip injuries management with semi-occlusive dressing. J Hand Surg (Edinburgh, Scotland) 18(4):416–422
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
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
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
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
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
Smith KL, Elliot D (2000) The extended Segmuller flap. Plast Reconstr Surg 105(4):1334–1346
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The study was approved by the ethics committee of the regional State Chamber of Medicine (approval number FF 61/2016) and written informed consent was obtained from the participants indicating their permission to scientific publication of the data.
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Arsalan-Werner, A., Brui, N., Mehling, I. et al. Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap. Arch Orthop Trauma Surg 139, 1171–1178 (2019). https://doi.org/10.1007/s00402-019-03198-4
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DOI: https://doi.org/10.1007/s00402-019-03198-4