Application of a modified dorsoulnar artery pedicle flap in the repair of thumb tip defects: A case report

Mao,Tian; Xie,Renguo; Wang,Guheng; Xing,Shuguo

doi:10.3892/etm.2020.8583

Application of a modified dorsoulnar artery pedicle flap in the repair of thumb tip defects: A case report

Authors:
- Tian Mao
- Renguo Xie
- Guheng Wang
- Shuguo Xing
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Affiliations: Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
Published online on: March 6, 2020 https://doi.org/10.3892/etm.2020.8583
Pages: 3300-3304
Copyright: © Mao et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Between February 2012 and March 2014 10 patients were admitted to the Affiliated Hospital of Nantong University for surgery due to a thumb tip defect. Nine of these patients were male and one was female and there were 7 cases of left thumb defects and 3 cases of right thumb defects. The surgical procedures followed were first, modification of the flap tail to an equilateral triangle, which facilitated pedicle suturing of soft tissue defects, caused mild tension and effectively reduced venous disorders, and second complete opening of the flap pedicle to the soft tissue defects at the tunnel. All patients were followed up at 6 and 12 months after surgery. Grip and pinch strength were measured 6 and 12 months after surgery. Static two‑point discrimination testing of the modified flap showed minor differences from the uninjured hand. Post‑surgery grip and pinch strength were restored to approximately 85% of the level of that in the uninjured hand. The modified dorsoulnar artery pedicle flap provided excellent thumb tip defect coverage and is an effective and safe technique for the restoration of grip and pinch strength to the hand after the repair of a thumb tip defect.

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1	Muzaffar AR, Chao JJ and Erdidrich JB: Posttraumatic thumb reconstruction. Plast Rdconstr Surg. 116:103e–122e. 2005.PubMed/NCBI View Article : Google Scholar
2	Vdder NB and Hanel DP: The mangled upper exteremity. In: Green's Operative Hand Surgery. Green D (ed). 5th edition. Elsevier/Churchill Livingstone, New York, NY, pp1587-1628, 2005.
3	Tang JB, Elliot D, Adani R, Saint-Cyr M and Stang F: Repair and reconstruction of thumb and finger tip injures: A global view. Clin Plast Surg. 41:325–359. 2014.PubMed/NCBI View Article : Google Scholar
4	Foucher G, Boulas HJ and Braga Da Silva J: The use of flaps in the treatment of fingertip injuries. World J Surg. 15:458–462. 1991.PubMed/NCBI View Article : Google Scholar
5	Bertehlli JA and Koury Z: Neurocutaneous island flap in the hand: Anatomical basis and preliminary results. Br J Plast Surg. 45:586–590. 1992.PubMed/NCBI View Article : Google Scholar
6	Mitsunaga N, Mihara M, Koshima I, Gonda K, Takuya I, Kato H, Araki J, Yamamoto Y, Yuhei O, Todokoro T, et al: Digital artery perforator (DAP) flaps: Modifications for fingertip and finger stump reconstruction. J Plast Reconstr Aesthet Surg. 63:1312–1317. 2010.PubMed/NCBI View Article : Google Scholar
7	Zhu L, Xu Q, Kou W, Ning B and Jia T: Outcome of free digital artery perforator flap transfer for reconstruction of fingertip defects. Indian J Orthop. 48:594–598. 2014.PubMed/NCBI View Article : Google Scholar
8	Usami S, Kawahara S, Yamaguchi Y and Hirase T: Homodigital artery flap reconstruction for fingertip amputation: A comparative study of the oblique triangular neurovascular advancement flap and the reverse digital artery island flap. J Hand Surg Eur Vol. 40:291–297. 2015.PubMed/NCBI View Article : Google Scholar
9	Yu YD, Zhang YZ, Bi WD and Wu T: Functional sensory function recovery of random-pattern abdominal skin flap in the repair of fingertip skin defects. Exp Ther Med. 5:830–834. 2013.PubMed/NCBI View Article : Google Scholar
10	Panse N and Sahasrabudhe P: The ulnar digital artery perforator flap: A new flap for little finger reconstruction-a preliminary report. Indian J Plast Surg. 43:190–194. 2010.PubMed/NCBI View Article : Google Scholar
11	Horta R, Barbosa R, Oliveira L, Amarante JM, Marques M, Cruz Reis J and Rebelo M: Neurosensible reconstruction of the thumb in an emergency situation: Review of 107 case. Tech Hang Up Extrem Surg. 13:85–89. 2009.PubMed/NCBI View Article : Google Scholar
12	Teran P, Carnero S, Miranda R, Trillo E and Estefanía M: Refinements in dorsoulnar flap of the thumb: 15 cases. J Hand Surg Am. 35:1356–1359. 2010.PubMed/NCBI View Article : Google Scholar
13	Cheah AE and Chong AK: Soft-tissue coverage of the hand. Curr Orth Practice. 23:336–345. 2012.
14	Han D, Sun H, Jin Y, Wei J and Li Q: A technique for the non-microsurgical reconstruction of thumb tip amputations. J Plast Reconstr Aesthet Surg. 66:973–977. 2013.PubMed/NCBI View Article : Google Scholar
15	Ramirez AR and Gonzalez SM: Arteries of the thumb: Description of anatomical variations and review of the literature. Plast Reconstr Surg. 129:468e–476e. 2012.PubMed/NCBI View Article : Google Scholar
16	Tang JB: Uncommon methods of flexor tendon and tendon-bone repairs and grafting. Hand Clin. 29:215–221. 2013.PubMed/NCBI View Article : Google Scholar
17	Tang JB: Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol. 34:137–138. 2009.PubMed/NCBI View Article : Google Scholar
18	Tang JB and Avanessian B: Clinical reports: The importance of reporting a surgeon's level of expertise. J Hand Surg Am. 40:416–417. 2015.PubMed/NCBI View Article : Google Scholar
19	Fess EE and Moran C: Clinical Assessment Recommendations. American Society of Hand Therapists, Indianapolis, 1981.
20	Hrabowski M, Kloeters O and Germann G: Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: Surgical technique. J Hand Surg Am. 35:659–662. 2010.PubMed/NCBI View Article : Google Scholar
21	Moschella F and Cordova A: Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg. 117:920–926. 2006.PubMed/NCBI View Article : Google Scholar
22	Wang C, Xu J and Zhang L: Applied anatomy of the island flap pediceled with dorsal digital vessels. Chin J Clin Anat. 24:514–517. 2006.
23	Ramirez MA and Means KR Jr: Digital soft tissue trauma: A concise primer of soft tissue reconstruction of traumatic hand injuries. Iowa Orthop J. 31:110–20. 2011.PubMed/NCBI
24	Gatewood A: A plastic repair of finger defects without hospitalization. JAMA. 87(1479)1926.
25	Cronin TD: The cross finger flap: A new method of repair. Am Surg. 17:419–425. 1951.PubMed/NCBI
26	Weeks PM and Wray RC (eds): Management of Acute Hand Injury: A Biological Approach. Mosby, St. Louis, MI, 1973.
27	Maruyama Y: The reverse dorsal metacarpal flap. Br J Plast Surg. 43:24–27. 1990.PubMed/NCBI View Article : Google Scholar
28	Dellon AL: Management of peripheral nerve problems in the upper and lower extremity using quantitative sensory testing. Hand Clin. 15:697–715. 1999.PubMed/NCBI
29	Nizamis K, Rijken NH, Mendes A, Janssen MM, Bergsma A and Koopman BF: A novel setup and protocol to measure the range of motion of the wrist and the hand. Sensors (Basel). 18(E1881)2018.PubMed/NCBI View Article : Google Scholar
30	MacDermid JC: Measurement of health outcomes following tendon and nerve repair. J Hand Ther. 18:297–312. 2005.PubMed/NCBI View Article : Google Scholar