Parmak ucu doku kayıplarının dijital arterperforatör flepleri ile rekonstrüksiyonu

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.

Keywords

• Dijital arter perforatör flep; parmak ucu; pulpa rekonstrüksiyonu

Reconstruction of fingertip defects with digital artery perforator flap

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.

Keywords

• Digital artery perforator flap
• fingertip
• pulp reconstruction

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