Versatility of the Cross-Finger Flap for Reconstruction of the Thumb (original) (raw)
Related papers
Versatility of the Cross-Finger Flap for Reconstruction of the Thumb Corresponding author
2017
The thumb is responsible for 40% of the hand function. Therefore, when resurfacing of the thumb is required, cross-fi nger flap may prove very useful. In this paper, we reported three cases where cross-fi nger flaps were used successfully in order to cover soft tissue defects of the thumb`s distal phalanx. No major complications were encountered. All patients were satisfi ed with the cosmetic aspect of the reconstruction procedure (9 on VAS). All the fi ngers were fully functional, with a mean TAM score of 266° for the donor fi ngers and a mean DASH score of 2.16 after 1 year from injury. Using this technique, we obtain good quality soft and bulky tissue to restore the original form of the thumb in order to prevent function loss by reducing length and primary suture of the fi nger. Therefore, we consider this method very effective in covering vital structures with almost no morbidity related to the donor site. Alongside other previous papers describing this technique, we concluded t...
Plastic Amp Reconstructive Surgery, 2012
Various surgical techniques contribute to repair distal defects of the fingers, especially thumb as traumatic loss, diminishes or eliminates the thumb prehensile abilities and may affect overall hand function. The goal of reconstruction should be maximum restoration of hand function. Being the only opposing digit against the others, when thumb is involved, functional loss maybe more severe than anticipated. Because of its major contribution to overall hand function, correction of deformities involving the thumb is crucial. Adequate length, mobility, stability and sensation are the goals of a functional thumb reconstruction. It appears that the FD-MCA flap is one of the best solutions for cover of simple or complex skin loss of the thumb. Its technical performance is easy, and it gives durable, sensate and stable skin cover.
Cross-finger Flap to the Thumb: Quest for an Alternate Donor
Indian Journal of Plastic Surgery, 2020
Background Distal thumb injuries are managed by multiple local and regional flaps. The cross-finger flap (CFF) is one versatile flap used to cover such defects. The donor finger to the thumb is classically described to be the index finger (IF). However, with the index finger being the second most important finger, it causes further debilitation of the already injured hand. Our aim was to find an alternate donor finger to spare the index finger. Methods and Materials A prospective observational study was conducted on 10 patients with distal thumb injuries who were admitted between November 2018 and July 2019. Ring finger (RF) was used as donor for CFF in all the cases. The subjects were assessed for first web space angle, Kapandji score, total range of movement (TRM) of long fingers, and global hand function using Michigan hand outcome questionnaire (MHQ) after flap division. Results There was no first web contracture and TRM of IF remained unaffected. However, TRM of RF was significantly reduced. But this being a relatively unimportant finger, there was no significant reduction in global hand function, as evaluated by the MHQ score. Conclusion The ring finger is a good alternative for index finger as donor for CFF to the thumb, because it provides adequate tissue along with comfortable positioning and easy maintenance of local hygiene. Moreover, it preserves global hand function by sparing the IF.
Clinical Evaluation of Reconstruction of Thumb Defect with First Dorsal Metacarpal Artery Flap.
IOSR Journals , 2019
Thumb defects are not so uncommon. Causes include burn and traumatic injuries. Reconstruction of these defects require sensate flap. First dorsal metacarpal artery flap is very good option for pulp defect of the thumb. Our study was done over a period of 1 year and involved 8 cases of thumb pulp defects treated at our institution. The flap size ranged from 2 × 1.5 cm to 4 × 3 cm. We had only one complication in the form of partial flap necrosis, which fortunately healed following debridement without the need for a secondary procedure. All our cases were done under brachial block or local anesthesia with tourniquet control. All the patients had satisfactory outcome with minimal or no donor site morbidity.
International Journal of Research in Orthopaedics, 2019
Background: Reconstruction of complex soft tissue defects of the thumb is a challenging problem. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. The aim of this study is to report our experience on the safety and functional outcome of the innervated first dorsal metacarpal artery flap (FDMA) for soft tissue defects of thumb.Methods: During 18 month period, nine patients with a mean age of 29 years, male:female ratio of 8:1 underwent coverage of soft tissue defects of the thumb, of various volar and dorsal defects, using an innervated first dorsal metacarpal artery flap. Indications were postburn deformities and acute trauma. None of the patients had any neurorraphy. Outcome of the Holevich modification of FDMA flap was assessed with regards to survival and function, reachability for different locations of the thumb, recovery of sensation in terms of two-point discriminati...
Utility of First Dorsal Metacarpal Artery Flap for Thumb Defects
Indian Journal of Plastic Surgery
Background Reconstruction of thumb tip, while providing a durable and sensate flap, is a challenging task. It is important as thumb accounts for 50% of hand functions. Options for coverage are: healing by secondary intention, local/regional flaps, microsurgical toe wraparound flap, etc. First dorsal metacarpal artery (FDMA) flap is one regional flap that has been used for thumb cover, usually for defects till interphalangeal joint or just distal to it. We present our case series for FDMA flap and its variations for thumb reconstruction. We also report reverse FDMA flap cover for reconstruction of defects over distal phalanx of thumb. Methods The procedure was performed in patients with partial loss of thumb soft tissue in 16 patients presenting during 2017 to 2020. The FDMA flap was performed according to the standard technique. In case after “planning in reverse,” it was seen that the reach of FDMA flap was insufficient, reverse FDMA flap was done. Physiotherapy for index finger an...
Evaluation of versatility and outcomes of the first dorsal metacarpal artery flap in thumb defects
Ulusal Travma Acil Cerrahi Dergisi, 2023
It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options. METHODS: A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature. RESULTS: The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was "good" (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients. CONCLUSION: Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.
Cross-Finger Flaps Outcome and Modification
https://www.ijrrjournal.com/IJRR\_Vol.10\_Issue.2\_Feb2023/IJRR-Abstract05.html, 2023
Background: Injuries to fingers are frequently encountered since these are the most exposed parts of the body and are in contact with devices and tools so are exposed to a multitude of risks. Various surgical methods such as skin grafting, stump closure, and microvascular reconstruction are in the armamentarium of the plastic surgeon. The cross-finger flap was described originally in 1950 and is one of the workhorse flaps for finger reconstruction and can be done as described originally or as a modification in multiple scenarios of finger trauma. Methods: This is a prospective single-centre multi-surgeon study carried out on 35 patients from 2018 to 2021 on patients undergoing crossfinger flap. All cross-finger flaps or any modification such as reverse cross-finger flap, or cross-finger flap on graft reposition were included. Each patient was analysed as per the aetiology, the treatment received, the reconstructive procedures done, the functional and aesthetic outcome, and any postoperative complications and their management. Results: The average follow-up of patients was two years. 22 out of 35 patients were male, and in 28 patients the injury had occurred in the right hand. The average age of patients was 34.5 years. Conclusion: Cross-finger flap is a simple and reliable flap among the various reconstructive options available for finger injuries. The modifications such as reverse cross-finger and graft reposition flap increase its application. The cosmetic outcome is usually satisfactory and the return of protective sensations is seen in most cases. At times it is a trade-off between extensive microvascular procedure and a marginally short finger with or without nails.
International Journal of Science and Research Archive, 2021
Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the in...