Download PDF
J Reconstr Microsurg 2015; 31(06): 426-433
DOI: 10.1055/s-0035-1548743
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reverse Dorsoradial Flaps for Thumb Coverage Show Increased Sensory Recovery with Smaller Flap Sizes

Y.C. Sun
1   Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
,
Q.Z. Chen
1   Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
,
J. Chen
1   Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
,
Y.P. Gong
1   Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
,
J.H. Gu
1   Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
› Author Affiliations
Further Information

Publication History

23 November 2014

04 February 2015

Publication Date:
24 March 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Background Reverse homodigital dorsoradial (RHD) flap has been developed to repair soft-tissue defects of the thumb. However, few articles have reported this flap with long-term follow-up. This retrospective study was designed to evaluate the RHD flap and investigate factors affecting sensory recovery.

Methods From February 2010 to February 2011, 19 patients were treated consecutively with RHD flap without neurorrhaphy. At final follow-up, flap sensibility was assessed by Semmes–Weinstein (SW) monofilament, moving two-point discrimination (M-2PD), and static two-point discrimination (S-2PD) tests. Patient satisfaction, active range-of-motion of the joints, patient complications, and cold intolerance severity score questionnaire were sequentially evaluated. The patients were divided into two groups based on the S-2PD results and another two groups based on flap size.

Results The mean SW monofilament sensitivity and M-2PD and S-2PD scores on the flap were 4.01 g and 9.26 mm, and 10.63 mm, respectively. Highly positive correlations existed between the flap size and the M-2PD and S-2PD scores. Moreover, in the respective groups based on S-2PD scores and flap size, no statistical difference was found among age, sex, and follow-up time, but the flap size and S-2PD scores were statistically different.

Conclusions RHD flap without neurorrhaphy is a recommendable technique for relatively small-sized thumb-defect reconstruction, which can achieve a satisfactory sensory recovery.

Keywords

thumb - soft-tissue defect - reverse homodigital dorsoradial flap - neurorrhaphy
 

  • References

  • 1 Kutler W. A new method for finger tip amputation. J Am Med Assoc 1947; 133 (1) 29
    CrossrefPubMedGoogle Scholar
  • 2 Atasoy E, Ioakimidis E, Kasdan ML, Kutz JE, Kleinert HE. Reconstruction of the amputated finger tip with a triangular volar flap. A new surgical procedure. J Bone Joint Surg Am 1970; 52 (5) 921-926
    PubMedGoogle Scholar
  • 3 Venkataswami R, Subramanian N. Oblique triangular flap: a new method of repair for oblique amputations of the fingertip and thumb. Plast Reconstr Surg 1980; 66 (2) 296-300
    CrossrefPubMedGoogle Scholar
  • 4 Rose EH, Norris MS, Kowalski TA, Lucas A, Fleegler EJ. The “cap” technique: nonmicrosurgical reattachment of fingertip amputations. J Hand Surg Am 1989; 14 (3) 513-518
    CrossrefPubMedGoogle Scholar
  • 5 Cronin TD. The cross finger flap: a new method of repair. Am Surg 1951; 17 (5) 419-425
    PubMedGoogle Scholar
  • 6 Hueston J. Local flap repair of fingertip injuries. Plast Reconstr Surg 1966; 37 (4) 349-350
    CrossrefPubMedGoogle Scholar
  • 7 Varitimidis SE, Dailiana ZH, Zibis AH, Hantes M, Bargiotas K, Malizos KN. Restoration of function and sensitivity utilizing a homodigital neurovascular island flap after amputation injuries of the fingertip. J Hand Surg [Br] 2005; 30 (4) 338-342
    CrossrefPubMedGoogle Scholar
  • 8 Koshima I, Urushibara K, Fukuda N , et al. Digital artery perforator flaps for fingertip reconstructions. Plast Reconstr Surg 2006; 118 (7) 1579-1584
    CrossrefPubMedGoogle Scholar
  • 9 Koshima I, Inagawa K, Urushibara K, Okumoto K, Moriguchi T. Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 2000; 105 (5) 1666-1674
    CrossrefPubMedGoogle Scholar
  • 10 Lin CH, Lin YT, Sassu P, Lin CH, Wei FC. Functional assessment of the reconstructed fingertips after free toe pulp transfer. Plast Reconstr Surg 2007; 120 (5) 1315-1321
    CrossrefPubMedGoogle Scholar
  • 11 Huang SH, Wu SH, Lai CH , et al. Free medial plantar artery perforator flap for finger pulp reconstruction: report of a series of 10 cases. Microsurgery 2010; 30 (2) 118-124
    PubMedGoogle Scholar
  • 12 Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fingertip: methods of evaluation and treatment. An algorithmic approach. Plast Reconstr Surg 2008; 122 (3) 105e-117e
    CrossrefPubMedGoogle Scholar
  • 13 Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg 2006; 117 (3) 920-926
    CrossrefPubMedGoogle Scholar
  • 14 Bao QY, Xiao CW, Peng F, Han D, Wang T, Gu YD. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg 2014; 30 (1) 15-20
    PubMedGoogle Scholar
  • 15 Hrabowski M, Kloeters O, Germann G. Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique. J Hand Surg Am 2010; 35 (4) 659-662
    CrossrefPubMedGoogle Scholar
  • 16 Moschella F, Cordova A, Pirrello R, Brunelli F. Anatomic basis for the dorsal radial flap of the thumb: clinical applications. Surg Radiol Anat 1996; 18 (3) 179-181
    CrossrefPubMedGoogle Scholar
  • 17 Zhang X, Shao X, Ren C, Zhang Z, Wen S, Sun J. Reconstruction of thumb pulp defects using a modified kite flap. J Hand Surg Am 2011; 36 (10) 1597-1603
    CrossrefPubMedGoogle Scholar
  • 18 Chen C, Zhang X, Shao X, Gao S, Wang B, Liu D. Treatment of thumb tip degloving injury using the modified first dorsal metacarpal artery flap. J Hand Surg Am 2010; 35 (10) 1663-1670
    CrossrefPubMedGoogle Scholar
  • 19 Tang JB. Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2. J Hand Surg Eur Vol 2007; 32 (2) 118-129
    PubMedGoogle Scholar
  • 20 Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23 (4) 575-587
    CrossrefPubMedGoogle Scholar
  • 21 Chung KC, Hamill JB, Walters MR, Hayward RA. The Michigan Hand Outcomes Questionnaire (MHQ): assessment of responsiveness to clinical change. Ann Plast Surg 1999; 42 (6) 619-622
    CrossrefPubMedGoogle Scholar
  • 22 Irwin MS, Gilbert SE, Terenghi G, Smith RW, Green CJ. Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms. J Hand Surg [Br] 1997; 22 (3) 308-316
    CrossrefPubMedGoogle Scholar
  • 23 Dellon AL, Kallman CH. Evaluation of functional sensation in the hand. J Hand Surg Am 1983; 8 (6) 865-870
    CrossrefPubMedGoogle Scholar
  • 24 Zhang X, He Y, Shao X, Li Y, Wen S, Zhu H. Second dorsal metacarpal artery flap from the dorsum of the middle finger for coverage of volar thumb defect. J Hand Surg Am 2009; 34 (8) 1467-1473
    CrossrefPubMedGoogle Scholar
  • 25 Moberg E. Aspects of sensation in reconstructive surgery of the upper extremity. J Bone Joint Surg Am 1964; 46: 817-825
    PubMedGoogle Scholar
  • 26 Urushidate S, Yotsuyanagi T, Yamauchi M , et al. Modified thin abdominal wall flap (glove flap) for the treatment of acute burns to the hands and fingers. J Plast Reconstr Aesthet Surg 2010; 63 (4) 693-699
    CrossrefPubMedGoogle Scholar
  • 27 Cohen BE, Cronin ED. An innervated cross-finger flap for fingertip reconstruction. Plast Reconstr Surg 1983; 72 (5) 688-697
    CrossrefPubMedGoogle Scholar
  • 28 Fejjal N, Belmir R, El Mazouz S, Gharib N, Abbassi A, Belmahi A. Reversed cross finger subcutaneous flap: A rapid way to cover finger defects. Indian J Plast Surg 2008; 41 (1) 55-57
    CrossrefPubMedGoogle Scholar
  • 29 Megerle K, Palm-Bröking K, Germann G. The cross-finger flap [in German]. Oper Orthop Traumatol 2008; 20 (2) 97-102
    CrossrefPubMedGoogle Scholar
  • 30 Lai-jin L, Xu G. The reverse dorsal metacarpal flap: experience with 153 cases. Ann Plast Surg 2006; 56 (6) 614-617
    CrossrefPubMedGoogle Scholar
  • 31 Koch H, Bruckmann L, Hubmer M, Scharnagl E. Extended reverse dorsal metacarpal artery flap: clinical experience and donor site morbidity. J Plast Reconstr Aesthet Surg 2007; 60 (4) 349-355
    CrossrefPubMedGoogle Scholar
  • 32 Rybka FJ, Pratt FE. Thumb reconstruction with a sensory flap from the dorsum of the index finger. Plast Reconstr Surg 1979; 64 (2) 141-144
    CrossrefPubMedGoogle Scholar
  • 33 Earley MJ. The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg [Br] 1986; 11 (2) 163-174
    CrossrefPubMedGoogle Scholar
  • 34 Brunelli F, Gilbert A. Vascularization of the thumb. Anatomy and surgical applications. Hand Clin 2001; 17 (1) 123-138
    PubMedGoogle Scholar
  • 35 Ramírez AR, Gonzalez SM. Arteries of the thumb: description of anatomical variations and review of the literature. Plast Reconstr Surg 2012; 129 (3) 468e-476e
    CrossrefPubMedGoogle Scholar
  • 36 Braga-Silva J, Gehlen D, Bervian F, da Cunha GL, Padoin AV. Randomized prospective study comparing reverse and direct flow island flaps in digital pulp reconstruction of the fingers. Plast Reconstr Surg 2009; 124 (6) 2012-2018
    CrossrefPubMedGoogle Scholar