1/33. A modified reversed digital island flap incorporating the proper digital nerve.A standard reversed digital artery flap is based on the digital artery and vena comitantes alone, leaving the proper digital nerve intact. In the authors' opinion, in situations in which the fingertip pulp is lost completely, it is unnecessary to leave the nerve in situ. Using their technique, the proper digital nerve is included in the pedicle. The pedicle is raised as a monobloc of fatty tissue containing the small veins important for drainage. The proper digital nerve in the flap is sutured to the stump of the opposite proper digital nerve. They found this flap to be very reliable, and quite easy and quick to raise. A patient is presented and discussed in detail.- - - - - - - - - - ranking = 1keywords = island (Clic here for more details about this article) |
2/33. A reverse ulnar hypothenar flap for finger reconstruction.A reverse-flow island flap from the hypothenar eminence of the hand was applied in 11 patients to treat palmar skin defects, amputation injuries, or flexion contractures of the little finger. There were three female and eight male patients, and their ages at the time of surgery averaged 46 years. A 3 x 1.5 to 5 X 2 cm fasciocutaneous flap from the ulnar aspect of the hypothenar eminence, which was located over the abductor digiti minimi muscle, was designed and transferred in a retrograde fashion to cover the skin and soft-tissue defects of the little finger. The flap was based on the ulnar palmar digital artery of the little finger and in three patients was sensated by the dorsal branch of the ulnar nerve or by branches of the ulnar palmar digital nerve of the little finger. Follow-up periods averaged 42 months. The postoperative course was uneventful for all patients, and all of the flaps survived without complications. The donor site was closed primarily in all cases, and no patient complained of significant donor-site problems. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer, as indicated by 5 mm of moving two-point discrimination. A reverse island flap from the hypothenar eminence is easily elevated, contains durable fasciocutaneous structures, and has a good color and texture match to the finger pulp. This flap is a good alternative for reconstruction of palmar skin and soft-tissue defects of the little finger.- - - - - - - - - - ranking = 0.5keywords = island (Clic here for more details about this article) |
3/33. Reversed dorsal digital and metacarpal island flaps supplied by the dorsal cutaneous branches of the palmar digital artery.The dorsal digital and metacarpal island flaps have been described for use in a variety of clinical situations. On the basis of the authors' previous angiographic studies, these two skin flaps were planned on the dorsum of the proximal phalanx or intermetacarpal space based on the vascular anastomoses between the proximal dorsal cutaneous branches of the palmar digital artery and the dorsal digital branches of the dorsal metacarpal artery at the level of the proximal phalanx. The authors present a series of 13 patients using these flaps. To reconstruct the injured finger pulp, the reverse dorsal digital flap was used in 5 patients, and the reverse dorsal metacarpal flap was used in 8 patients. Most of the 13 patients sustained a work-related injury. Associated injuries of bone, joint, or tendon occurred in most patients. In all patients, the skin defect was located distal to the proximal interphalangeal joint. The skin paddle was taken from the dorsal aspect of the middle and ring fingers or the first, second, third, and fourth metacarpal area. All flaps survived completely. Two patients who had the dorsal branch of the sensitive radial nerve anastomosed to the digital nerve recovered 6-mm two-point discrimination in the reverse dorsal digital flap. The results of this anatomic study and the authors' clinical experience confirm the reliability of the dorsal digital and metacarpal island flaps.- - - - - - - - - - ranking = 1.5keywords = island (Clic here for more details about this article) |
4/33. Fingertip reconstruction using a volar flap based on the transverse palmar branch of the digital artery.A new homodigital neurovascular island flap for fingertip reconstruction, called a volar digital island flap, is described. The flap is perfused from the proper digital artery through the transverse palmar branch, and is drained through the tiny venules and capillaries contained in the perivascular soft tissue. Between 1997 and 2000, 25 fingers from 23 patients with defects of the middle and distal phalangeal areas were reconstructed using this flap. All flaps survived well. Patient age ranged from 17 to 65 years (average age, 32.5 years). Long-term follow-up for more than 6 months was possible in 15 fingers from 14 patients. light touch and temperature sensation could be detected in all the flaps evaluated. The mean value of the static two-point discrimination test was 4.2 mm. Although this flap requires the sacrifice of important volar skin, it provides excellent padding and sensation for fingertip reconstruction. The authors think that this new flap is an alternative choice for coverage of fingertip defects.- - - - - - - - - - ranking = 0.5keywords = island (Clic here for more details about this article) |
5/33. Combined second toe and partial nail transfer from the big toe by means of an exteriorized pedicle.The hand of a three-year old girl was reconstructed by means of a bilateral second toe transplantation following traumatic amputation of all five digits. In a second operation, aimed at reconstructing the index finger, the nail apparatus of the big toe was transferred to the thumb as an "island flap" based on a pedicle from the second toe. The thumb was subsequently lengthened enabling a three-fingered hand to be obtained with only minimal functional impairment of the feet. The authors suggest an original technique allowing transfer of the second toe and of the big toe nail in only one operative stage. The technique of leaving the pedicle exteriorized during transplantation (autonomization) facilitates positioning of the nail onto the recipient site and eliminates subsequent problems of commissural retraction.- - - - - - - - - - ranking = 0.25keywords = island (Clic here for more details about this article) |
6/33. Trimmed second toetip transfer for reconstruction of claw nail deformity of the fingers.Claw nail deformities of the fingers have been repaired by many methods, but the results have been cosmetically unsatisfactory because of loss of the distal phalangeal bone and the short nail bed. We have employed a trimmed second toetip including the distal phalangeal bone and excluding the germinal matrix as a vascularised composite flap for two patients with claw nail deformity of the fingers. The advantages of this method are that the repaired nail regrows to normal size and has bilateral nail folds. We believe that, in comparison with other conventional local or island flaps, this composite flap is functionally and cosmetically ideal for the repair of claw nail deformities.- - - - - - - - - - ranking = 0.25keywords = island (Clic here for more details about this article) |
7/33. Reverse digital artery island flap in the elderly.The following case report illustrates the successful use of the reverse digital artery island flap in elderly patients. The reverse digital artery island flap is a recognised method of providing good quality soft tissue cover to the amputated fingertip. First described in 1986 by Kojima, Lai and Han have reported their experience of 52 and 120 of these flaps, respectively. The majority of patients in the literature are less than 50 years old, with ages ranging from 3 to 62 years. The flap is based upon reversed flow in the digital artery via a communicating branch from the contralateral artery at a point 5mm proximal to the distal interphalangeal joint crease. In the two cases reported below, we have shown that the indications for this type of homodigital flap reconstruction for fingertip amputations can be safely extended to elderly patients.- - - - - - - - - - ranking = 1.5keywords = island (Clic here for more details about this article) |
8/33. Microsurgical second dorsal metacarpal artery cutaneous and tenocutaneous flap for distal finger reconstruction: anatomic study and clinical application.In this paper, we report on the anatomical study of 34 cadaveric forearms with red latex injection and the clinical application of this study to 11 cases of microsurgical second dorsal metacarpal artery (SDMA) flaps. There were 8 cutaneous cases and 3 tenocutaneous cases using SDMA flaps for distal finger reconstruction. The SDMA was classified into 2 types and 4 subtypes according to its anatomical origin and course. Type I (76.5%) originated from the dorsal branch of the radial artery at the snuffbox. Type II (23.5%) originated from the perforating branch of the deep palmar arch at the bases of second and third metacarpal bones. Diameter of the SDMA was 1.2 /- 0.2 mm at its snuffbox origin, and 1.0 /- 0.1 mm at the base of the second and third metacarpal bones. Clinically, microsurgical SDMA free flaps were raised and transferred for repair of finger injuries. Ten flaps survived completely. One flap failed due to thrombosis of vascular anastomosis. In conclusion, the second dorsal metacarpal artery is a constant and reliable vessel for microvascular anastomosis in microsurgical SDMA flap transfer. This flap can be used as an alternative for hand and finger reconstruction, and especially repair of a distal phalanx, when either an orthograde or retrograde island SDMA flap is unable to reach the defect.- - - - - - - - - - ranking = 0.25keywords = island (Clic here for more details about this article) |
9/33. Use of dorsal ulnar neurocutaneous island flap in the treatment of chronic postburn palmar contractures.In the present study, the authors evaluated efficiency of the "dorsal ulnar neurocutaneous island flap" in the coverage of palmar defects resulting from radical release of selected chronic postburn contractures. Eight white male hands with palmar contracture were treated with this flap between November 2001 and December 2003. The mean follow-up period was 11.6 months. The flap, which was planned on the ulnar aspect of the forearm and the hand, is transferred to the palmar defect. The subcutaneous pedicle of the flap was skin-grafted to avoid tension. All operations were successful. Distal flap necrosis that healed by secondary intention was observed in one of the eight flaps. Seventy-five degrees was the maximum improvement in metacarpophalangeal (MP) joint extension achieved in the little finger. Grasp function of the hand dramatically improved and the bulk of the flap did not interfere with grasping. No recurrent palmar contracture was observed. The authors concluded that the dorsoulnar neurocutaneous island flap can be used effectively in the treatment of postburn palmar contractures. The safety of the flap can be enhanced by grafting the intervening skin between the pivot point of the flap and the palmar defect.- - - - - - - - - - ranking = 1.5keywords = island (Clic here for more details about this article) |
10/33. Innervated reverse island flap based on the end dorsal branch of the digital artery: surgical technique.Fingertip or pulp loss of the fingers is observed frequently in unskilled workers. To reconstruct a sensate fingertip or pulp we designed the innervated reverse island flap based on the end dorsal branch of the digital artery, which was harvested from the dorsum of the middle phalanx. The sensation of the fingertip or pulp was re-established through coaptation of the proper branches of the digital dorsal nerves to the digital nerves. Three fingertip or pulp defects were reconstructed with this technique. All patients achieved satisfactory functional and cosmetic results. The mean follow-up time was 7.7 months. The average size of the flaps was 1.6 x 1.8 cm. The average static 2-point discrimination and moving 2-point discrimination of the flaps were 4.6 mm and 3.0 mm, respectively. The technique we applied seems to be an excellent option for 1-stage reconstruction of fingertip or pulp defects.- - - - - - - - - - ranking = 1.25keywords = island (Clic here for more details about this article) |
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