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Parmak ucu doku kayıplarının dijital arterperforatör flepleri ile rekonstrüksiyonu

Year 2015, , 18 - 22, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0049

Abstract

Amaç: Parmak ucundaki doku kayıplarının rekonstrüksiyonunda zorluklar gözlenebilir. Bu klinik ça¬lışmanın amacı parmak ucu doku kayıplarında dijital arter perforator (DAP) flepleriyle olan deneyi¬mimizi sunmak ve avantajlarını tartışmaktır.

Çalışma planı: Temmuz 2007 ile Şubat 2012 tarihleri arasında parmak ucu doku kaybının rekons¬trüksiyonu için 15 hastaya DAP flep uygulandı. Perforatör ada flebi radial yada ulnar taraftan uygun olan kaldırıldı. Tüm olgularda donor alan cilt greftiyle kapatıldı.

Bulgular: Flep Boyutları 2x1 cm- 2.5x1.5 cm arasındaydı. Hastaların büyük çoğunluğunda (15 has¬tanın 12’sinde) geçici venöz yetmezlik izlendi, ancak ek bir tedavi gereksinimi olmadan iyileşti. Tüm fleplerde greftlenen donor sahalar sorunsuz bir şekilde iyileşti. Ortalama takip süresi 22 aydı(7-62 ay). Tüm hastalar normal günlük aktivitelerine ve işlerine ortalama 39 gün (30-45 gün) içerisinde dön¬düler. Son değerlendirmede İki nokta ayrımı testinin ortalama değeri 5.3 mm ve Semmes Weinstein Monofilament testinin sonuçları ise 3,61 ile 4,56 arasındaydı.

Çıkarımlar: Tek aşamalı, kolay uygulanabilen, iyi duyusal iyileşme gösteren, dijital arterleri koruma gibi bir çok avantajı olan güvenilir bir yöntemdir.

References

  • Barbato BD, Guelmi K, Romano SJ, Mitz V, Lemerle JP. The- nar flap rehabilitated: a review of 20 cases. Ann Plast Surg 1996;37:135-9.
  • Elliot D, Wilson Y. V-Y advancement of the entire volar soft tissue of the thumb in distal reconstruction. J Hand Surg Br 1993;18:399-402.
  • Atasoy E, Ioakimidis E, Kasdan ML, Kutz JE, Kleinert HE. Reconstruction of the amputated finger tip with a triangu- lar volar flap. A new surgical procedure. J Bone Joint Surg Am 1970;52:921-6.
  • Heistein JB, Cook PA. Factors affecting composite graft survival in digital tip amputations. Ann Plast Surg 2003;50:299-303.
  • Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fin- gertip: methods of evaluation and treatment. An algorithmic ap- proach. Plast Reconstr Surg 2008;122:105e-117e.
  • Nishikawa H, Smith PJ. The recovery of sensation and func- tion after cross-finger flaps for fingertip injury. J Hand Surg Br 1992;17:102-7.
  • Koshima I, Urushibara K, Fukuda N, Ohkochi M, Nagase T, Gonda K, et al. Digital artery perforator flaps for fingertip recon- structions. Plast Reconstr Surg 2006;118:1579-84.
  • Mitsunaga N, Mihara M, Koshima I, Gonda K, Takuya I, Kato H, et al. Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction. J Plast Reconstr Aes- thet Surg 2010;63:1312-7.
  • Rose EH, Norris MS, Kowalski TA, Lucas A, Fleegler EJ. The “cap” technique: nonmicrosurgical reattachment of fingertip am- putations. J Hand Surg Am 1989;14:513-8.
  • Chen SY, Wang CH, Fu JP, Chang SC, Chen SG. Composite grafting for traumatic fingertip amputation in adults: tech- nique reinforcement and experience in 31 digits. J Trauma 2011;70:148-53.
  • Venkataswami R, Subramanian N. Oblique triangular flap: a new method of repair for oblique amputations of the fingertip and thumb. Plast Reconstr Surg 1980;66:296-300.
  • Evans DM, Martin DL. Step-advancement island flap for finger- tip reconstruction. Br J Plast Surg 1988;41:105-11.
  • Lanzetta M, Mastropasqua B, Chollet A, Brisebois N. Versatility of the homodigital triangular neurovascular island flap in finger- tip reconstruction. J Hand Surg Br 1995;20:824-9.
  • Adani R, Busa R, Castagnetti C, Bathia A, Caroli A. Homodigi- tal neurovascular island flaps with “direct flow” vascularization. Ann Plast Surg 1997;38:36-40.
  • Ozaksar K, Toros T, Sügün TS, Bal E, Ademoğlu Y, Kaplan I. Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap. J Hand Surg Eur Vol 2010;35:125-9.
  • Kojima T, Tsuchida Y, Hirasé Y, Endo T. Reverse vascular pedi- cle digital island flap. Br J Plast Surg 1990;43:290-5.
  • 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;45:443-53.
  • Yildirim S, Avci G, Akan M, Aköz T. Complications of the re- verse homodigital island flap in fingertip reconstruction. Ann Plast Surg 2002;48:586-92.
  • Lee HB, Tark KC, Rah DK, Shin KS. Pulp reconstruction of fingers with very small sensate medial plantar free flap. Plast Re- constr Surg 1998;101:999-1005.
  • Yokoyama T, Hosaka Y, Kusano T, Morita M, Takagi S. Finger palmar surface reconstruction using medial plantar venous flap: possibility of sensory restoration without neurorrhaphy. Ann Plast Surg 2006;57:552-6.
  • Koshima I, Narushima M, Mihara M, Nakai I, Akazawa S, Fu- kuda N, et al. Island medial plantar artery perforator flap for re- construction of plantar defects. Ann Plast Surg 2007;59:558-62.
  • Koshima I, Urushibara K, Inagawa K, Hamasaki T, Moriguchi T. Free medial plantar perforator flaps for the resurfacing of fin- ger and foot defects. Plast Reconstr Surg 2001;107:1753-8.
  • Ozcanli H, Coskunfirat OK, Bektas G, Cavit A. Innervated digi- tal artery perforator flap. J Hand Surg Am 2013;38:350-6.
  • Suzuki S, Koshima I. Digital artery perforator flap for recon- struction of fingertip after resection of melanoma in situ. Hand Surg 2011;16:395-8.

Reconstruction of fingertip defects with digital artery perforator flap

Year 2015, , 18 - 22, 19.03.2015
https://doi.org/10.3944/AOTT.2015.14.0049

Abstract

Objective: The aim of this study was to present our findings for the use of the digital artery perforator (DAP) flap in the covering of digital pulp defects.

Methods: The study included 15 patients who underwent reconstruction of the fingertip using a DAP flap between July 2007 and February 2012. The blood supply of the perforator island flap was based on the distal and either radial or ulnar sides of the digit. Donor sites were closed using skin grafting in all cases. Static two-point discrimination (s2PD) and Semmes-Weinstein monofilament (SWM) testing was performed at the final follow-up to determine extension loss and sensorial improvement.

Results: Mean follow-up was 22 (range: 7 to 62) months. Flaps size was between 2x1 cm and 2.5x1.5 cm. Temporary venous congestion was observed in 12 of the 15 patients and was without complication. All patients returned to their normal daily activities and work within an average of 39 (range: 30 to 45) days. Mean two-point discrimination was 5.3 mm and SWM test results were between 3.61 and 4.56 at the final follow-up.

Conclusion: The DAP flap appears to be a reliable procedure with several advantages as a single-stage operating procedure, easy to harvest, good sensory recovery and preservation of digital arteries.

References

  • Barbato BD, Guelmi K, Romano SJ, Mitz V, Lemerle JP. The- nar flap rehabilitated: a review of 20 cases. Ann Plast Surg 1996;37:135-9.
  • Elliot D, Wilson Y. V-Y advancement of the entire volar soft tissue of the thumb in distal reconstruction. J Hand Surg Br 1993;18:399-402.
  • Atasoy E, Ioakimidis E, Kasdan ML, Kutz JE, Kleinert HE. Reconstruction of the amputated finger tip with a triangu- lar volar flap. A new surgical procedure. J Bone Joint Surg Am 1970;52:921-6.
  • Heistein JB, Cook PA. Factors affecting composite graft survival in digital tip amputations. Ann Plast Surg 2003;50:299-303.
  • Lemmon JA, Janis JE, Rohrich RJ. Soft-tissue injuries of the fin- gertip: methods of evaluation and treatment. An algorithmic ap- proach. Plast Reconstr Surg 2008;122:105e-117e.
  • Nishikawa H, Smith PJ. The recovery of sensation and func- tion after cross-finger flaps for fingertip injury. J Hand Surg Br 1992;17:102-7.
  • Koshima I, Urushibara K, Fukuda N, Ohkochi M, Nagase T, Gonda K, et al. Digital artery perforator flaps for fingertip recon- structions. Plast Reconstr Surg 2006;118:1579-84.
  • Mitsunaga N, Mihara M, Koshima I, Gonda K, Takuya I, Kato H, et al. Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction. J Plast Reconstr Aes- thet Surg 2010;63:1312-7.
  • Rose EH, Norris MS, Kowalski TA, Lucas A, Fleegler EJ. The “cap” technique: nonmicrosurgical reattachment of fingertip am- putations. J Hand Surg Am 1989;14:513-8.
  • Chen SY, Wang CH, Fu JP, Chang SC, Chen SG. Composite grafting for traumatic fingertip amputation in adults: tech- nique reinforcement and experience in 31 digits. J Trauma 2011;70:148-53.
  • Venkataswami R, Subramanian N. Oblique triangular flap: a new method of repair for oblique amputations of the fingertip and thumb. Plast Reconstr Surg 1980;66:296-300.
  • Evans DM, Martin DL. Step-advancement island flap for finger- tip reconstruction. Br J Plast Surg 1988;41:105-11.
  • Lanzetta M, Mastropasqua B, Chollet A, Brisebois N. Versatility of the homodigital triangular neurovascular island flap in finger- tip reconstruction. J Hand Surg Br 1995;20:824-9.
  • Adani R, Busa R, Castagnetti C, Bathia A, Caroli A. Homodigi- tal neurovascular island flaps with “direct flow” vascularization. Ann Plast Surg 1997;38:36-40.
  • Ozaksar K, Toros T, Sügün TS, Bal E, Ademoğlu Y, Kaplan I. Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap. J Hand Surg Eur Vol 2010;35:125-9.
  • Kojima T, Tsuchida Y, Hirasé Y, Endo T. Reverse vascular pedi- cle digital island flap. Br J Plast Surg 1990;43:290-5.
  • 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;45:443-53.
  • Yildirim S, Avci G, Akan M, Aköz T. Complications of the re- verse homodigital island flap in fingertip reconstruction. Ann Plast Surg 2002;48:586-92.
  • Lee HB, Tark KC, Rah DK, Shin KS. Pulp reconstruction of fingers with very small sensate medial plantar free flap. Plast Re- constr Surg 1998;101:999-1005.
  • Yokoyama T, Hosaka Y, Kusano T, Morita M, Takagi S. Finger palmar surface reconstruction using medial plantar venous flap: possibility of sensory restoration without neurorrhaphy. Ann Plast Surg 2006;57:552-6.
  • Koshima I, Narushima M, Mihara M, Nakai I, Akazawa S, Fu- kuda N, et al. Island medial plantar artery perforator flap for re- construction of plantar defects. Ann Plast Surg 2007;59:558-62.
  • Koshima I, Urushibara K, Inagawa K, Hamasaki T, Moriguchi T. Free medial plantar perforator flaps for the resurfacing of fin- ger and foot defects. Plast Reconstr Surg 2001;107:1753-8.
  • Ozcanli H, Coskunfirat OK, Bektas G, Cavit A. Innervated digi- tal artery perforator flap. J Hand Surg Am 2013;38:350-6.
  • Suzuki S, Koshima I. Digital artery perforator flap for recon- struction of fingertip after resection of melanoma in situ. Hand Surg 2011;16:395-8.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Haluk Ozcanli This is me

Gamze Bektas This is me

Ali Cavit This is me

Ahmet Duymaz This is me

O. Koray Coskunfirat This is me

Publication Date March 19, 2015
Published in Issue Year 2015

Cite

APA Ozcanli, H., Bektas, G., Cavit, A., Duymaz, A., et al. (2015). Reconstruction of fingertip defects with digital artery perforator flap. Acta Orthopaedica Et Traumatologica Turcica, 49(1), 18-22. https://doi.org/10.3944/AOTT.2015.14.0049
AMA Ozcanli H, Bektas G, Cavit A, Duymaz A, Coskunfirat OK. Reconstruction of fingertip defects with digital artery perforator flap. Acta Orthopaedica et Traumatologica Turcica. March 2015;49(1):18-22. doi:10.3944/AOTT.2015.14.0049
Chicago Ozcanli, Haluk, Gamze Bektas, Ali Cavit, Ahmet Duymaz, and O. Koray Coskunfirat. “Reconstruction of Fingertip Defects With Digital Artery Perforator Flap”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 1 (March 2015): 18-22. https://doi.org/10.3944/AOTT.2015.14.0049.
EndNote Ozcanli H, Bektas G, Cavit A, Duymaz A, Coskunfirat OK (March 1, 2015) Reconstruction of fingertip defects with digital artery perforator flap. Acta Orthopaedica et Traumatologica Turcica 49 1 18–22.
IEEE H. Ozcanli, G. Bektas, A. Cavit, A. Duymaz, and O. K. Coskunfirat, “Reconstruction of fingertip defects with digital artery perforator flap”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 1, pp. 18–22, 2015, doi: 10.3944/AOTT.2015.14.0049.
ISNAD Ozcanli, Haluk et al. “Reconstruction of Fingertip Defects With Digital Artery Perforator Flap”. Acta Orthopaedica et Traumatologica Turcica 49/1 (March 2015), 18-22. https://doi.org/10.3944/AOTT.2015.14.0049.
JAMA Ozcanli H, Bektas G, Cavit A, Duymaz A, Coskunfirat OK. Reconstruction of fingertip defects with digital artery perforator flap. Acta Orthopaedica et Traumatologica Turcica. 2015;49:18–22.
MLA Ozcanli, Haluk et al. “Reconstruction of Fingertip Defects With Digital Artery Perforator Flap”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 1, 2015, pp. 18-22, doi:10.3944/AOTT.2015.14.0049.
Vancouver Ozcanli H, Bektas G, Cavit A, Duymaz A, Coskunfirat OK. Reconstruction of fingertip defects with digital artery perforator flap. Acta Orthopaedica et Traumatologica Turcica. 2015;49(1):18-22.