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

2. 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

3. 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.

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

5. 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

6. 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

7. 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

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

9. 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

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

11. 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

12. 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

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

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

15. 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

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

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

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

19. 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

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

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

22. 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

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

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

25. 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

26. 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.

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

28. 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

29. Thank you for your attention