Reconstruction of fingertip injury by local and regional flaps Tran Nguyen Trinh Hanh MD. Supervisor : Vo Van Chau MD.

INTRODUCTION A common injury.Bone and tendon exposure Inappropriate management lead to significant disability and functional impairment of the hand TREATMENT GOALS : Maintain length of the finger Provide a painless fingertip with durable and sensate skin

INTRODUCTION We used: Local flaps: Atasoy, Moberg, Homodigital neurovascular island Regional flap: Cross – finger This study evaluates the ability of every flap to cover every fingertip injury.

MATERIALS AND METHODS Based on the zone and the plane of injury to indicate which flap has application

MATERIALS AND METHODS Patients injury in zone 2, 3 with transverse, dorsal, volar and lateral amputation Follow – up evaluation: Flap Healing time Time to return to work Donor area morbidity Patient satisfaction

RESULTS 75 fingers(64 patients) from 3/2004 to 4/2005 in hospital for traumatology and orthopaedics Age : 15 – 57 Male: 43 , Female : 21 Industrial accident: 51, Domestic accident: 8 , Other: 5

The index and the middle finger were most frequently involved RESULTS Fingers involved The index and the middle finger were most frequently involved 11 27 2 13 22

RESULTS The zone and the plane of injury lateral 11 28 32 4 volar transverse dorsal 2 3 22 53 zone

RESULTS Dorsal Volar Transverse Lateral Thumb 1MOB 1Cross 4MOB 2MOB The distribution of the flaps according to the type of amputation Dorsal Volar Transverse Lateral Thumb 1MOB 1Cross 4MOB 2MOB Finger 1Atasoy 6Homodigital 18 Cross-finger 24 Atasoy 5Homo 2Cross

RESULTS Mean follow up time: 5 months All flaps survived well All skin graft of the donor site survived well.

RESULTS Fingertip sensitive General deterioration in sensitivity in all flaps but the worst results in cross-finger flap. Flaps 2-point discrimination (mm) Atasoy Moberg Homodigital Cross-finger 4,5 4,4 5,6 7,9

RESULTS Healing time and time to return to work are long in cross-finger flaps. Flaps Healing time(day) Time to return to work(day) Atasoy Moberg Homodigital Cross-finger 7 10 14 30 20 40

RESULTS Patient satisfaction Flap Very satisfied Satisfied Not satisfied Atasoy Moberg Homodigital Cross-finger 26 8 12 10 1 5

DISCUSSION We used Atasoy for transvere amputation in zone 2 of 24 fingers 9 months F/U

DISCUSSION To mobilize the flap we just divide the fibrous septa, not scissor the distal aspect of the wound Volar flap advancement : We : 10mm Kojima T. : 15mm

DISCUSSION We used Moberg for 9 thumbs defects. Defects with length <2.5cm: easily reconstruction 12months F/U Pre-op Post-op

DISCUSSION Nail deformity in one patient with the length of defect = 2,5cm

DISCUSSION The leading edge of the flap is sutured together to improve the finger pulp contour

DISCUSSION 17 Homodigital neurovascular island flaps were used for distal finger defects in zone 3 with transverse, volar, and lateral amputation Defects with length<1.5cm Design of the flap

DISCUSSION Release the island and neurovascular pedicle Advance the flap to cover the fingertip

DISCUSSION Average flap size : 1.4 x 1.8cm Maximum : 1.5 x 2.5cm 12 months F/U

DISCUSSION 23 Cross – finger flaps: 18 volar amputation( defect with length>2cm) 2 dosal amputation 3 lateral amputation Average flap size : 1.5 x 2 cm

DISCUSSION Cross – finger flap for volar defect >2cm in length, especially in multiple fingers 12 months F/U

DISCUSSION Cross – thumb flaps indicated where the defect is on the radial aspect of the index finger 12 months F/U

DISCUSSION We used a simple test of Steenlage E. to determine the viability of cross-finger pedicle flap. One flap was divided at 17 days instead of 3 weeks

DISCUSSION The advantages of Atasoy, Moberg and homodigital neurovascular island flap are: single – staged,supply skin coverage to normal than any regional flaps. Cross-finger has some disadvantages: two-staged, long healing time, decrease in 2-point discrimination.

CONCLUSION Atasoy is best for transverse amputation in zone 2 Moberg used for distal palmar thumb defect with length < 2.5 cm

CONCLUSION Homodigtal neurovascular island flap is best for reconstruction of distal zone 3 with defect < 1.5cm in length Cross – finger flap is best for fingertip amputation with extensive skin and pulp loss and exposure bone and tendon,especially in multiple fingers

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