Araştırma Makalesi
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Neurovascular Heterodigital Island Flap for Digital Pulp Defect Reconstruction: 58 Case Series

Yıl 2023, Cilt: 7 Sayı: 3, 259 - 262, 31.12.2023
https://doi.org/10.30565/medalanya.1397435

Öz

Aim: Our study aims to report the neurovascular heterodigital island flap reconstruction for finger pulp defects.

Patients and Methods: This study included 58 patients presenting to our clinic with pulp defects between 2014 and 2022. The average age of the patients was 26 years (20 - 56 years). Injuries were Allen type 2 for 18 patients, type 3 for 33 patients, and type 4 for 7 patients. Pulp defects were caused by crush injury (n:42) and sharps injury (n:16).

Results: None of the flaps administered to the participating patients developed any total loss. Three patients developed partial loss in the distal flap. Six patients were found to have superficial tissue infection. Two patients were found to have hyperpigmentation and hyperesthesia. While one patient with Allen type 3 pulp defect was detected to have 10 degrees of flexion contracture in the distal interphalangeal (DIP) joint and 5 degrees of flexion contracture in the proximal interphalangeal joint, three patients were found to have 5 degrees of flexion contracture only in the DIP joint. The mean static two-point discrimination of the pulp-administered flap was 5.2 mm (3-8 mm) and on the contralateral side was 3 mm. The mean Semmes-Weinstein monofilament test was 3.18 g (2.96 – 4.7 g) in the pulp administered flap and 2.92 g in the contralateral side.

Conclusions: Reconstruction of pulp defects with neurovascular heterodigital island flap is a reliable treatment option with satisfactory functional and sensory outcomes.

Kaynakça

  • 1. Allen MJ. Conservative management of finger tip injuries in adults. Hand. 1980 Oct;12(3):257-65. doi: 10.1016/s0072-968x(80)80049-0.
  • 2. Kwon HJ, Yoon S, Han HH, Moon SH. Partial second-toe pulp free flap for fingertip reconstruction: Experience and surgical tips to minimize complications. Microsurgery. 2021 Oct;41(7):629-636. doi: 10.1002/micr.30804.
  • 3. Kutler W. A new method for finger tip amputation. J Am Med Assoc. 1947 Jan 4;133(1):29. doi: 10.1001/jama.1947.62880010007007.
  • 4. 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 Jul;52(5):921-6. PMID: 4920906.
  • 5. Spyropoulou GA, Shih HS, Jeng SF. Free Pulp Transfer for Fingertip Reconstruction-The Algorithm for Complicated Allen Fingertip Defect. Plast Reconstr Surg Glob Open. 2016;3(12):e584. doi: 10.1097/GOX.0000000000000569.
  • 6. Liu H, Regmi S, He Y, Hou R. Thumb Tip Defect Reconstruction Using Neurovascular Island Pedicle Flap Obtained From Long Finger. Aesthetic Plast Surg. 2016 Oct;40(5):755-60. doi: 10.1007/s00266-016-0674-1.
  • 7. Zhang X, Wang Z, Ma X, Jin Y, Wang J, Yu H, Li T, Xiu X. Repair of finger pulp defects using a free second toe pulp flap anastomosed with the palmar vein. J Orthop Surg Res. 2022 Jul 16;17(1):352. doi: 10.1186/s13018-022-03232-z.
  • 8. Germann G, Rudolf KD, Levin SL, Hrabowski M. Fingertip and Thumb Tip Wounds: Changing Algorithms for Sensation, Aesthetics, and Function. J Hand Surg Am. 2017 Apr;42(4):274-284. doi: 10.1016/j.jhsa.2017.01.022.
  • 9. Littler JW. Theneurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg (1946). 1953;12(5):303e319.
  • 10. Pham DT, Netscher DT. Vascularized Heterodigital Island Flap for Fingertip and Dorsal Finger Reconstruction. J Hand Surg Am. 2015 Dec;40(12):2458-64. doi: 10.1016/j.jhsa.2015.06.112.
  • 11. Öztürk Aİ, Turğut MC, Engin MÇ, Köse A, Baran T, Şencan A. [Pulp Replantation. A case report]. Acta Med. Alanya 2018;2(2):124-126. Turkish DOI:10.30565/medalanya.381817
  • 12. Lai CS, Lin SD, Chou CK, Tsai CW. A versatile method for reconstruction of finger defects: reverse digital artery flap. Br J Plast Surg. 1992 Aug-Sep;45(6):443-53. doi: 10.1016/0007-1226(92)90208-f. PMID: 1393248.
  • 13. Chi Z, Pafitanis G, Pont LEP, Vijayan R, Marcelli S, Gao W, Li Z, Zhou X, Song D, Yang P. The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction. J Plast Surg Hand Surg. 2018 Apr;52(2):111-116. doi: 10.1080/2000656X.2017.1360317.

Parmak Pulpa Defektlerinin Nörovasküler Heterodijital Ada Flebi ile Rekonstrüksiyonu: 58 Vakalık Seri

Yıl 2023, Cilt: 7 Sayı: 3, 259 - 262, 31.12.2023
https://doi.org/10.30565/medalanya.1397435

Öz

Amaç: Çalışmamızın amacı el parmak pulpa defekti olan hastalarda nörovasküler heterodijital ada flebi ile pulpa rekonstrüksiyonu sonuçlarımızı bildirmektir.

Patients ve Metod: Kliniğimize 2014-2022 yılları arasında pulpa defekti ile başvuran 58 hasta (42 erkek, 16 kadın) çalışmaya dahil edilmiştir. Hastaların yaş ortalaması 26’dır (20-56 yaş). Hastaların 18 tanesi Allen tip 2, 33 tanesi Allen tip 3 ve 7 tanesi Allen tip 4 yaralanmalardı. Pulpa defektleri crush yaralanma (n:42) ve kesici alet yaralanması (n:16) ile meydana gelmişti.

Bulgular: Çalışmaya dahil edilen hastalara uygulanan fleplerin hiçbirisinde total kayıp gelişmemiştir. Üç hastada flep distalinde kısmi kayıp gelişti. Hastaların 6 tanesinde yüzeyel doku enfeksiyonu görüldü. Donör saha morbiditesi olarak 2 hastada hiperpigmentasyon ile birlikte günlük hayatını etkilemeyecek şekilde hiperestezi tespit edildi. Allen tip 3 pulpa defektli olan 1 hastada distal IP (interphalangeal) eklemde 10 derece fleksiyon kontraktürü ile birlikte PIP eklemde 5 derece fleksiyon kontraktürü tespit edilirken, 3 hastada sadece distal IP eklemde 5 derece fleksiyon kontraktürü tespit edildi. Flep uygulanmış olan pulpaların ortalama statik 2 nokta diskriminasyonu 5,2 mm (3-8 mm) iken karşı tarafta ortalama 3 mm idi. Ortalama Semmes-Weinstein monofilament testleri flep uygulanmış olan pulpada 3.18 g (2.96 – 4.7 g) iken karşı tarafta 2.92 g idi.

Sonuç: Akut el yaralanmaları sonrası oluşan pulpa defektlerinin nörovasküler heterodijital ada flebi ile rekonstrüksiyonu fonksiyonel, estetik ve duyusal anlamda tatminkar sonuçlara sahiptir.

Kaynakça

  • 1. Allen MJ. Conservative management of finger tip injuries in adults. Hand. 1980 Oct;12(3):257-65. doi: 10.1016/s0072-968x(80)80049-0.
  • 2. Kwon HJ, Yoon S, Han HH, Moon SH. Partial second-toe pulp free flap for fingertip reconstruction: Experience and surgical tips to minimize complications. Microsurgery. 2021 Oct;41(7):629-636. doi: 10.1002/micr.30804.
  • 3. Kutler W. A new method for finger tip amputation. J Am Med Assoc. 1947 Jan 4;133(1):29. doi: 10.1001/jama.1947.62880010007007.
  • 4. 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 Jul;52(5):921-6. PMID: 4920906.
  • 5. Spyropoulou GA, Shih HS, Jeng SF. Free Pulp Transfer for Fingertip Reconstruction-The Algorithm for Complicated Allen Fingertip Defect. Plast Reconstr Surg Glob Open. 2016;3(12):e584. doi: 10.1097/GOX.0000000000000569.
  • 6. Liu H, Regmi S, He Y, Hou R. Thumb Tip Defect Reconstruction Using Neurovascular Island Pedicle Flap Obtained From Long Finger. Aesthetic Plast Surg. 2016 Oct;40(5):755-60. doi: 10.1007/s00266-016-0674-1.
  • 7. Zhang X, Wang Z, Ma X, Jin Y, Wang J, Yu H, Li T, Xiu X. Repair of finger pulp defects using a free second toe pulp flap anastomosed with the palmar vein. J Orthop Surg Res. 2022 Jul 16;17(1):352. doi: 10.1186/s13018-022-03232-z.
  • 8. Germann G, Rudolf KD, Levin SL, Hrabowski M. Fingertip and Thumb Tip Wounds: Changing Algorithms for Sensation, Aesthetics, and Function. J Hand Surg Am. 2017 Apr;42(4):274-284. doi: 10.1016/j.jhsa.2017.01.022.
  • 9. Littler JW. Theneurovascular pedicle method of digital transposition for reconstruction of the thumb. Plast Reconstr Surg (1946). 1953;12(5):303e319.
  • 10. Pham DT, Netscher DT. Vascularized Heterodigital Island Flap for Fingertip and Dorsal Finger Reconstruction. J Hand Surg Am. 2015 Dec;40(12):2458-64. doi: 10.1016/j.jhsa.2015.06.112.
  • 11. Öztürk Aİ, Turğut MC, Engin MÇ, Köse A, Baran T, Şencan A. [Pulp Replantation. A case report]. Acta Med. Alanya 2018;2(2):124-126. Turkish DOI:10.30565/medalanya.381817
  • 12. Lai CS, Lin SD, Chou CK, Tsai CW. A versatile method for reconstruction of finger defects: reverse digital artery flap. Br J Plast Surg. 1992 Aug-Sep;45(6):443-53. doi: 10.1016/0007-1226(92)90208-f. PMID: 1393248.
  • 13. Chi Z, Pafitanis G, Pont LEP, Vijayan R, Marcelli S, Gao W, Li Z, Zhou X, Song D, Yang P. The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction. J Plast Surg Hand Surg. 2018 Apr;52(2):111-116. doi: 10.1080/2000656X.2017.1360317.
Toplam 13 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Muhsin Dursun 0000-0002-4024-5059

Yayımlanma Tarihi 31 Aralık 2023
Gönderilme Tarihi 29 Kasım 2023
Kabul Tarihi 11 Aralık 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 7 Sayı: 3

Kaynak Göster

Vancouver Dursun M. Neurovascular Heterodigital Island Flap for Digital Pulp Defect Reconstruction: 58 Case Series. Acta Med. Alanya. 2023;7(3):259-62.

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