J Korean Soc Surg Hand.  2016 Jun;21(2):70-76. 10.12790/jkssh.2016.21.2.70.

Reverse Digital Island Flap with Skin Strip Retention to Prevent Flap Congestion

• Shin JY
• An MY
• Roh SG
• Lee NH
• Yang KM

• KMID: 2328390
• DOI: http://doi.org/10.12790/jkssh.2016.21.2.70

Abstract

PURPOSE
The reverse digital island flap is useful for the repair of various fingertip injuries. We present a modified surgical technique with skin strip elevation for the prevention of postoperative congestion.
METHODS
From January 2005 to October 2015, we performed 31 reconstructive procedures for finger injury using a reverse digital artery island flap with and without skin strip retention. Patients' clinical characteristics, surgical outcomes, and complications were investigated.
RESULTS
All flaps survived and there were no donor site problems. The mean follow-up time was 5 months (range, 3-8 months). In skin strip retention group, mild venous congestion was observed in 1 case, although it resolved spontaneously. Another case retained flexion contracture, and 2 patients had stiffness at the distal interphalangeal joint. Whereas, in no retention group, venous congestion was observed in 3 cases, 1 patient had partial flap necrosis and 2 patient suffer in flexion contracture at metacarpophalangeal joint.
CONCLUSION
The reverse digital island flap procedure produces consistent results and is reliable for the treatment of fingertip injury. Our modified surgical technique of elevating the flap accompanied by skin strip retention helps prevent postoperative congestion.

Keyword

Fingertip injury; Reverse digital island flap; Prevention of congestion

MeSH Terms

Arteries
Contracture
Estrogens, Conjugated (USP)*
Finger Injuries
Follow-Up Studies
Humans
Hyperemia
Joints
Metacarpophalangeal Joint
Necrosis
Skin*
Tissue Donors
Estrogens, Conjugated (USP)

Figure

• 

  Fig. 1. A 61-year-old-male with posttraumatic amputation, the defect size was about 1.5×2.0 cm over the left thumb. (A) Reverse-flow heterodigital island flap with skin strip was elevated from index finger. (B) The flap with skin strip was transferred into the defect. (C) Five months after the operation, the flap circulation was intact.

• 

  Fig. 2. Partial flap necrosis of reverse digital island flap in no skin retention group.

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