Dorsolateral flap vs. radial midpalmar island flap in the treatment of traumatic distal thumb injuries. Clinical evaluation
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Published:
Aug 3, 2020
Keywords:
Distal thumb lesions, dorsolateral flap, radial midpalmar island flap
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Abstract
Objective: To clinically evaluate patients with combined distal thumb lesions treated by a dorsolateral flap or radial midpalmar island flap. Materials and methods: We retrospectively compared 20 patients (14 males and 6 females, averaging 35 years) with combined distal thumb traumatic lesions, who were operated on by two surgeons using different techniques. Patients had no previous surgical history and a minimum follow-up period of 24 months. Subjective outcome was evaluated by satisfaction index (SI), visual analogue scale (VAS), and QuickDASH score. Objective outcome was evaluated by two-point discrimination test (TPDT), average surgical time (ST), and need for digital spatial reeducation (DSR). Results: Time from admission to medical discharge averaged 7 weeks (range, 6-8). Average postoperative results: VAS for pain, 01/10 (both groups); IS, 97% vs. 92% (dorsolateral flap group vs. radial midpalmar island flap); TPDT, 4 mm vs. 6 mm; QuickDASH, 2.5 vs. 8; ST, 45 minutes vs. 60 minutes; need for DSR, 0 vs. 4 cases. Conclusion: Both the dorsolateral flap and the radial midpalmar island flap techniques were effective in the treatment of distal thumb traumatic lesions, although the dorsolateral flap produced better results in terms of objective evaluation and required less ST.
Level of Evidence: III
Level of Evidence: III
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Pastrana, M. J., Zaidenberg, C. R., Zaidenberg, E. E., Juárez Cesca, F., Martínez, E., & Pastrana, J. A. (2020). Dorsolateral flap vs. radial midpalmar island flap in the treatment of traumatic distal thumb injuries. Clinical evaluation. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 85(3), 204-213. https://doi.org/10.15417/issn.1852-7434.2020.85.3.891
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Clinical Research
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References
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2. Pho RW. Restoration of sensation using a local neurovascular island flap as a primary procedure in extensive pulp loss of the fingertip. Injury 1976;8(1):20-4. https://doi.org/10.1016/0020-1383(76)90004-8
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(distal thenar perforator-based island flap). Plast Reconstr Surg 2010;125(2):601-8.
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7. Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F. Repair and reconstruction of thumb and finger tip injuries:
A global view. Clin Plastic Surg 2014;41(3):325-59. https://doi.org/10.1016/j.cps.2014.04.004
8. Evans DM, Bernardis C. A new classification for fingertip injuries. J Hand Surg Br 2000;25(1):58-60.
https://doi.org/10.1054/jhsb.1999.0305
9. Han D, Sun H, Jin Y, Wei J, Li Q. A technique for the non-microsurgical reconstruction of thumb tip amputations. J Plast Reconstr Aesthet Surg 2013;66(7):973-7. https://doi.org/10.1016/j.bjps.2013.03.013
10. Atasoy E, Ioakimidis E, Kasdan M, Kutz J, Kleinert H. Reconstruction of the amputated finger tip with a triangular volar flap. J Bone Joint Surg Am 1970;52(5):921-6. PMID: 4920906
11. Kutler W. A new method for finger tip amputation. JAMA 1947;1(133):29-30.
https://doi.org/10.1001/jama.1947.62880010007007
12. Foucher G, Braun B. A new island flap transfer from the dorsum of the index to the thumb. J Plast Reconstr Surg 1979;63(3):344-9. https://doi.org/10.1097/00006534-197903000-00008
13. Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg 2006;117(3):
920-6. https://doi.org/10.1097/01.prs.0000200665.73624.6d
14. Brunelli F. [Dorso-ulnar thumb flap]. Ann Chir Main Memb Super 1993;12(2):105-14. [En francés]
https://doi.org/10.1016/s0753-9053(05)80084-5
15. Mennen U, Wiese A. Fingertip injuries management with semi-occlusive dressing. J Hand Surg Br1993;18(4):
416-22. https://doi.org/10.1016/0266-7681(93)90139-7
16. Dellon AL. Evaluation of sensibility and re-education of sensation in the hand. Dellon Institutes for Peripheral
Nerve Surgery; 2014.
17. Dellon AL, Kallman CH. Evaluation of functional sensation in the hand. J Hand Surg Am 1983;8(6):865-70.
https://doi.org/10.1016/s0363-5023(83)80083-5
18. Hoppenreijs TJ, Freihofer HP, Browns A. Sensibility and cutaneous reinnervation of pectoralis major myocutaneous island flaps. A preliminary clinical report. J Craniomaxillofac Surg 1990;18(6):237-42.
https://doi.org/10.1016/s1010-5182(05)80422-6
19. Meltem Ayhan Oral, Kamuran Zeynep Sevim, Metin Görgü, Hasan Yücel Öztan. Sensory recovery with innervated and noninnervated flaps after total lower lip reconstruction: a comparative study. Plast Surg Int 2013;2013:643061. https://doi.org/10.1155/2013/643061
20. Shindo ML, Sinha UK, Rice DH. Sensory recovery in noninnervated free flaps for head and neck reconstruction. Laryngoscope 1995;105(12 Pt 1):1290-3. https://doi.org/10.1288/00005537-199512000-00005
21. Vriens JP, Acosta R, Soutar DS, Webster MH. Recovery of sensation in the radial forearm free flap in oral
reconstruction. Plast Reconstr Surg 1996;98(4):649-56. https://doi.org/10.1097/00006534-199609001-00008
22. Dykes R, Terzis J, Strauch B. Sensations from surgically transferred glabrous skin: central versus peripheral factors. Can J Neurol Sci 1979;6(4):437-45. https://doi.org/10.1017/s0317167100023842
23. Close LG, Truelson JM, Milledfe RA, Schweitzer C. Sensory recovery in noninnervated flaps used for oral cavity
and oropharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1995;121(9):967-72.
https://doi.org/10.1001/archotol.1995.01890090011002
2. Pho RW. Restoration of sensation using a local neurovascular island flap as a primary procedure in extensive pulp loss of the fingertip. Injury 1976;8(1):20-4. https://doi.org/10.1016/0020-1383(76)90004-8
3. Pho R. Local composite neurovascular island flap for skin cover in pulp loss of the thumb. J Hand Surg Am
1979;4(1):11-5. https://doi.org/10.1016/s0363-5023(79)80098-2
4. Germann G, Sauerbier M, Klaus R, Hrabowski M. Management of thumb injuries. J Hand Surg Am 2015;40(3):
614-22. https://doi.org/10.1016/j.jhsa.2014.09.028
5. Kim K, Kim E, Hwang J, Lee S. Thumb reconstruction using the radial midpalmar (perforator-based) island flap
(distal thenar perforator-based island flap). Plast Reconstr Surg 2010;125(2):601-8.
https://doi.org/10.1097/PRS.0b013e3181c82fd7
6. Lee D, Mignemi M, Crosby S. Fingertip injuries: an update on management. J Am Acad Orthop Surg 2013;21:
756-66. https://dx.doi.org/10.5435/JAAOS-21-12-756
7. Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F. Repair and reconstruction of thumb and finger tip injuries:
A global view. Clin Plastic Surg 2014;41(3):325-59. https://doi.org/10.1016/j.cps.2014.04.004
8. Evans DM, Bernardis C. A new classification for fingertip injuries. J Hand Surg Br 2000;25(1):58-60.
https://doi.org/10.1054/jhsb.1999.0305
9. Han D, Sun H, Jin Y, Wei J, Li Q. A technique for the non-microsurgical reconstruction of thumb tip amputations. J Plast Reconstr Aesthet Surg 2013;66(7):973-7. https://doi.org/10.1016/j.bjps.2013.03.013
10. Atasoy E, Ioakimidis E, Kasdan M, Kutz J, Kleinert H. Reconstruction of the amputated finger tip with a triangular volar flap. J Bone Joint Surg Am 1970;52(5):921-6. PMID: 4920906
11. Kutler W. A new method for finger tip amputation. JAMA 1947;1(133):29-30.
https://doi.org/10.1001/jama.1947.62880010007007
12. Foucher G, Braun B. A new island flap transfer from the dorsum of the index to the thumb. J Plast Reconstr Surg 1979;63(3):344-9. https://doi.org/10.1097/00006534-197903000-00008
13. Moschella F, Cordova A. Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg 2006;117(3):
920-6. https://doi.org/10.1097/01.prs.0000200665.73624.6d
14. Brunelli F. [Dorso-ulnar thumb flap]. Ann Chir Main Memb Super 1993;12(2):105-14. [En francés]
https://doi.org/10.1016/s0753-9053(05)80084-5
15. Mennen U, Wiese A. Fingertip injuries management with semi-occlusive dressing. J Hand Surg Br1993;18(4):
416-22. https://doi.org/10.1016/0266-7681(93)90139-7
16. Dellon AL. Evaluation of sensibility and re-education of sensation in the hand. Dellon Institutes for Peripheral
Nerve Surgery; 2014.
17. Dellon AL, Kallman CH. Evaluation of functional sensation in the hand. J Hand Surg Am 1983;8(6):865-70.
https://doi.org/10.1016/s0363-5023(83)80083-5
18. Hoppenreijs TJ, Freihofer HP, Browns A. Sensibility and cutaneous reinnervation of pectoralis major myocutaneous island flaps. A preliminary clinical report. J Craniomaxillofac Surg 1990;18(6):237-42.
https://doi.org/10.1016/s1010-5182(05)80422-6
19. Meltem Ayhan Oral, Kamuran Zeynep Sevim, Metin Görgü, Hasan Yücel Öztan. Sensory recovery with innervated and noninnervated flaps after total lower lip reconstruction: a comparative study. Plast Surg Int 2013;2013:643061. https://doi.org/10.1155/2013/643061
20. Shindo ML, Sinha UK, Rice DH. Sensory recovery in noninnervated free flaps for head and neck reconstruction. Laryngoscope 1995;105(12 Pt 1):1290-3. https://doi.org/10.1288/00005537-199512000-00005
21. Vriens JP, Acosta R, Soutar DS, Webster MH. Recovery of sensation in the radial forearm free flap in oral
reconstruction. Plast Reconstr Surg 1996;98(4):649-56. https://doi.org/10.1097/00006534-199609001-00008
22. Dykes R, Terzis J, Strauch B. Sensations from surgically transferred glabrous skin: central versus peripheral factors. Can J Neurol Sci 1979;6(4):437-45. https://doi.org/10.1017/s0317167100023842
23. Close LG, Truelson JM, Milledfe RA, Schweitzer C. Sensory recovery in noninnervated flaps used for oral cavity
and oropharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1995;121(9):967-72.
https://doi.org/10.1001/archotol.1995.01890090011002