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Comparison of Clinical Outcomes of Heterodigital Neurovascular Island Flap, Reverse Homodigital Neurovascular Island Flap, and Cross-Finger Flap Used for Fingertip Reconstruction

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Abstract

Objective

The fundamentals of fingertip defect reconstructions should be mainly to restore the sensation with contour and identical pulp volume, and texture. To achieve these, various flap techniques were described in which those had their own advantages and disadvantages to restore the fingertip injuries. This study aimed to compare clinical outcomes of three different local flap procedures widely used for the reconstruction of fingertip defects: heterodigital neurovascular island (HeNI) flap, reverse homodigital neurovascular island (rHoNI) flap, and cross-finger (CF) flap.

Methods

Between 2014 and 2019, statistical analysis of 58 patients undergoing reconstruction of fingertip defects of 2–5 digits by HeNI flap (n = 16), rHoNI flap (n = 17), or CF flap (n = 25), was performed retrospectively. All cases were reviewed regarding age, gender, etiology of trauma, duration of follow-up, the extent of the injury with the classification system PNB, Quick Disability of Arm, Shoulder, and Hand score (Q-DASH), cold intolerance symptom severity score (CISS), static 2-point discrimination test, ROM value of phalangeal joints and time to return to work.

Results

The mean age of all patients was 36.9 years with a male-to-female ratio of 5.4:1 and a mean follow-up of 26.72 months. The most common cause was work-related (n = 41). The mean of DASH score, CISS score, static 2-point discrimination, time to return to work, and ROM value of DIP joint did not significantly differ between the study groups. The mean ROM values of PIP and MCP joints of patients for CF flaps applied were significantly lower than HeNI flaps.

Conclusion

The use of HeNI flap for fingertip reconstruction is a reliable one-stage option in terms of improved ROM of finger joints.

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References

  1. Van de Berg, W. B., Vergeer, R. A., van der Sluis, C. K., Ten Duis, H. J., Werker, P., et al. (2012). Comparison of three types of treatment modalities on the outcome of fingertip injuries. Journal of Trauma and Acute Care Surgery, 72, 1681–1687. https://doi.org/10.1097/TA.0b013e318248bc8c

    Article  Google Scholar 

  2. Germann, G., Rudolf, K. D., Levin, S. L., & Hrabowski, M. (2017). Fingertip and thumb tip wounds: Changing algorithms for sensation, aesthetics, and function. Journal of Hand Surgery American, 42, 274–284. https://doi.org/10.1016/j.jhsa.2017.01.022

    Article  Google Scholar 

  3. Aydın, H., Utkan, S. C., & Ozyurekoglu, T. (2019). Comparison of homodigital dorsolateral flap and cross-finger flap for the reconstruction of pulp defects. Journal of Hand Surgery American, 44, 616–617. https://doi.org/10.1016/j.jhsa.2018.09.006

    Article  Google Scholar 

  4. Gulec, A., Ozdemir, A., Durgut, F., Yıldırım, A., & Acar, M. A. (2019). Comparison of innervated digital artery perforator flap versus homodigital reverse flow flap techniques for fingertip reconstruction. Journal of Hand Surgery American, 44, 801–806. https://doi.org/10.1016/j.jhsa.2018.11.004

    Article  Google Scholar 

  5. Ekinci, Y., & Gurbuz, K. (2020). Is the cross-finger flap a good option at the extensor zone defect? Joint Disease and Related Surgery, 31, 267–272. https://doi.org/10.5606/ehc.2020.73030

    Article  Google Scholar 

  6. Koch, H., Kielnhofer, A., Hubmer, M., & Scharnagl, E. (2005). Donor site morbidity in cross-finger flaps. British Journal of Plastic Surgery, 58, 1131–1135. https://doi.org/10.1016/j.bjps.2005.04.047

    Article  CAS  PubMed  Google Scholar 

  7. Evans, D. M., & Bernardis, C. (2000). A new classification for fingertip injuries. Journal of Hand Surgery European, 25, 58–60. https://doi.org/10.1054/jhsb.1999.0305

    Article  CAS  Google Scholar 

  8. Dogan, S. K., Ay, S., Evcik, D., & Baser, O. (2011). Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clinical Rheumatology, 30, 185–191. https://doi.org/10.1007/s10067-010-1470

    Article  Google Scholar 

  9. Tore, N. G., Gumussoy, M., & Oskay, D. (2019). Validity and reliability of the Turkish version of the cold intolerance symptom severity questionnaire, Turkish. Journal of Medical Science, 49, 1221–1227. https://doi.org/10.3906/sag-1808-170

    Article  Google Scholar 

  10. Roberto, A., Marcoccio, I., Tarallo, L., & Umberto, F. (2005). The reverse heterodigital neurovascular island flap for digital pulp reconstruction. Techiques in Hand Upper Extremity Surgery, 9, 91–95. https://doi.org/10.1097/01.bth.0000158973.08273.1f

    Article  Google Scholar 

  11. Wang, H., Yang, X., Chen, C., Yongxin, H., Bin, W., et al. (2019). Modified heterodigital neurovascular island flap for sensory reconstruction of pulp or volar soft tissue defect of digits. Journal of Hand Surgery American, 45, 67–71. https://doi.org/10.1016/j.jhsa.2019.04.014

    Article  Google Scholar 

  12. Regmi, S., Gu, J. X., & Zhang, N. C. (2016). Hong-jun L A systemic review of outcomes and complications of primary fingertip reconstruction using reverse-flow homodigital island flaps. Aesthetic Plastic Surgery, 40, 277–283. https://doi.org/10.1007/s00266-016-0624

    Article  PubMed  Google Scholar 

  13. Karjalaınen, T., & Jokıhaara, J. (2020). A review and meta-analysis of adverse events related to local flap reconstruction for digital soft tissue defects. Hand Clinics, 36, 107–121. https://doi.org/10.1016/j.hcl.2019.08.009

    Article  PubMed  Google Scholar 

  14. Kim, S. K. (2015). Digital artery perforator flaps. Archives of Reconstructive Microsurgery, 24, 50–55. https://doi.org/10.15596/ARMS.2015.24.2.50

    Article  Google Scholar 

  15. Usami, S., Kawahara, S., Yamaguvhi, T., & Hirase, Y. (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. Journal of Hand Surgery European, 40, 291–297. https://doi.org/10.1177/1753193413515134

    Article  CAS  Google Scholar 

  16. Al-Qattan, M. M. (2018). Time of return back to work and complications following cross-finger flaps in industrial workers: Comparison between immediate post-operative mobilization versus immobilization until flap division. International Journal of Surgery Case Reports, 42, 70–74. https://doi.org/10.1016/j.ijscr.2017.11.048

    Article  CAS  PubMed  Google Scholar 

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Education and Research Hospital, Kayseri, Turkey

    K. Gurbuz, F. Dogar & Y. Yontar

  2. Department of Orthopedics and Traumatology, Kayseri City Education and Training Hospital, Kocasinan, 38210, Kayseri, Turkey

    K. Gurbuz & Y. Yontar

  3. Department of Orthopedics and Traumatology, Sutcu Imam University Medical Faculty, Kahramanmaraş, Turkey

    F. Dogar

  4. Department of Orthopedics and Traumatology, Acıbadem Hospital, Kayseri, Turkey

    Y. Yontar

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Contributions

KG, FD and YY contributed to study conception and design. KG, FD and YY contributed to acquisition of data and analysis and interpretation of data. KG and FD contributed to drafting of manuscript. KG and YY contributed to critical revision. The authors respectfully ask if the following author contribution and acknowledgement may precede the bibliography in the main manuscript.

Corresponding author

Correspondence to K. Gurbuz.

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Conflict of interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Acibadem Mehmet Ali Aydinlar University Ethics Committee approved this study (approval date 27/06/2019; decided no: 2019/11-32). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

Informed consent

Informed consent for each participant of this study was checked again and achieved in their study patients file.

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Gurbuz, K., Dogar, F. & Yontar, Y. Comparison of Clinical Outcomes of Heterodigital Neurovascular Island Flap, Reverse Homodigital Neurovascular Island Flap, and Cross-Finger Flap Used for Fingertip Reconstruction. JOIO 56, 847–855 (2022). https://doi.org/10.1007/s43465-022-00605-8

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  • DOI: https://doi.org/10.1007/s43465-022-00605-8

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