Modifiye Ters Çapraz Parmak Flebi: Retikülodermo-Adipofasyal Flep

Abstract

Amaç: Ters çapraz parmak flebi, heterodijital ada flebinin avantajlarına sahip modifiye edilmiş bir çapraz parmak flebidir. Lokal flep rekonstrüksiyon teknikleri, ağırlıklı olarak küçük ve orta boyuttaki parmak defektlerini onarmak için kullanılmıştır. Bu flebi baş parmak hariç diğer parmaklar için uygun görülmüştür. Subdermal pleksus, bu flebin ana kanlanmasını sağlar. Bu çalışmanın amacı kliniğimizde tedavi edilen hastaların özellikerini ve sonuçlarını sunmaktır. Metod: Kliniğimizde el parmak dorsumunda ekspoze kemik, tendon, sinir veya damarlar olan; cilt ve yumuşak doku defekti olan; tümöral kitle eksizyonu sonrası rekonstrüksiyon gereği olan ‘Modifiye Ters Çapraz Parmak Flebi: Retikülodermo-Adipofasyal Flep’ tekniği yapılan 11 hasta retrospektif olarak araştırıldı. Sonuçları değerlendirildi. Bulgular: Hastaların yaş ortalamaları 57,2 idi. 7 Hastada travma sonrası el parmak dorsalinde defekt, 2 hastada tümöral kitle eksizyonu sonrası el parmak dorsalinde defekt, 1 hastada kronik yara eksizyonu sonrası el parmak dorsalinde defekt ve 1 hastada yanık skarı revizyonu sonrası el parmak dorsalinde defekti mevcut idi. Bu defektlere Modifiye Retikülodermo-Adipofasyal Ters Çapraz Parmak Flebi tekniği uygulandı. Hiçbir hastada flep kaybı görülmedi. Flep uygulanan bölgede inklüzyon kisti görülmedi. 2 hastada distal interfalangeal eklemde minimal, hafif eklem hareket kısıtlılığı mevcut idi. Yara yeri görünümü ve fonksiyonel kazanç kabul edilebilir ve iyi idi. Sonuç: Sadece retiküler dermisi adipofasyal dokuya dahil ederek daha güçlü bir flep hazırlandı. Retiküler dermisi kouryarak subdermal vasküler pleksusun hasarlanmasını da önlemiş olduk. Daha önceki uygulamalarda ters çapraz parmak flebi tasarımı; epidermis de-epitelize edildikten sonera dermoadipofasyal şeklinde planlanmış yada epidermis ve dermis de-epitelize edildikten sonra adipofasyal şeklinde tasarlanmış. Bu flep dizaynı; kıl, yağ ve ter bezi kaynaklı kistlerinin oluşma ihtimalini engel olmaktır. Ayrıca bu flep dizaynı kist oluşumuna engel olurken flebin kanlanmasına da katkı sağlamaktır.

Keywords

• Parmak dorsal defekti
• Ters retikülodermo-adipofasyal
• Çapraz parmak flebi.

Modifiye Reverse Cross Finger Flap: Retikülodermo-Adipofasyal Flap

Abstract

Objective: The reverse cross finger flap is a modified crossed finger flap with the advantages of the heterodigital island flap. Local flap reconstruction techniques have been used predominantly to repair small to medium-sized finger defects. This flap is considered suitable for all fingers except the thumb. The subdermal plexus provides the main blood supply of this flap. The aim of this study is to present the characteristics and results of patients treated in our clinic. Method: In our clinic, 11 patients with exposed bone, tendon, nerve or vessels on the dorsum of the finger; skin and soft tissue defects; and the need for reconstruction after tumoral mass excision were retrospectively investigated with the 'Modified Reverse Cross Finger Flap: Reticulodermo-Adipofascial Flap' technique. Results were evaluated. Results: The mean age of the patients was 57.2 years. 7 patients had a finger dorsal defect after trauma, 2 patients had a finger dorsal defect after tumoral mass excision, 1 patient had a finger dorsal defect after chronic wound excision, and 1 patient had a finger dorsal defect after burn scar revision. Modified Reticulodermo-Adipofascial Reverse Cross Finger Flap technique was applied to these defects. No flap loss was observed in any patient. No inclusion cyst was seen in the flap area. 2 patients had minimal, mild joint motion limitation at the distal interphalangeal joint. Wound site appearance and functional gain were acceptable and good. Conclusion: We prepared a stronger flap by incorporating only the reticular dermis into the adipofascial tissue. We also prevented the damage of the subdermal vascular plexus by couring the reticular dermis. In previous applications, the design of the reverse cross finger flap was planned as dermoadipofascial after the epidermis was de-epithelialized or as adipofascial after the epidermis and dermis were de-epithelialized. This flap design prevents the formation of cysts originating from hair, oil and sweat glands. In addition, this flap design prevents cyst formation and contributes to the blood supply of the flap.

Keywords

• finger dorsal defect
• reverse reticulodermo-adipofascial
• cross finger flap

References

1. 1. Jiao H , Ding X , Liu Y , Zhang H , Cao X. Clinical experience of multiple flaps for the reconstruction of dorsal digital defects. Int J Clin Exp Med. 2015;8(10):18058-65.
2. 2. Ekinci Y, Gürbüz K. Is the cross-finger flap a good option at the extensor zone defect?. Jt Dis Relat Surg. 2020;31(2):267-72.
3. 3. Gürbüz K, Uzun E, Ozan F. Covering the Dorsal Finger Defect with Reverse Cross Finger Flap. J Clin Anal Med. 2016;7(2):262-4.
4. 4. Elhoda MSA, Keshk TF, El Gamal AS, Taalab AA. A comparison between reversed cross-finger flap and Quaba flap in reconstruction of proximal dorsal digital defects. Egyptian J Surgery. 2021;39:622–31.
5. 5. Kim DH, Seo KB, Lee SH, Lee HJ, Kang HJ. Reverse digital artery crossfinger flap for reconstruction of failed finger replantation. J Orthop Surg (Hong Kong). 2019;27:2309499018816773.
6. 6. Fejjal N, Belmir R, El Mazouz S, Gharib N, Abbassi A, Belmahi A. Reversed cross fi nger subcutaneous fl ap: A rapid way to cover fi nger defects. Indian J Plast Surg. 2008:41(1):55-7
7. 7. Atasoy E. The Reverse Cross Finger Flap. J Hand Surg Am. 2016;41(1):122e128.
8. 8. Ahmed MM, Rao AL. Review of cross-finger flaps: Indications and modifications. International journal of science and research (IJSR). 2017;6(3):2299-303.

9. 9. Tabarestani A , Khlopas A, Wright T , Kim J. Basal Cell Carcinoma of the 2nd Digit Treated With the Reverse Cross-Finger Flap: A Case Report. Cureus. 16(7):e65105.
10. 10. Das De S, Sebastin SJ. Considerations in Flap Selection for Soft Tissue Defects of the Hand. Clin Plastic Surg. 2109;46(3):393–406.
11. 11. Sleem EA, Saied SM, Mohamed KA, Elsayed GY. A Comparison between Reversed Cross Finger Flap and Reversed Island Homo-digital Flap in Reconstruction of Distal Dorsal Digital Defects. The Egyptian Journal of Hospital Medicine. 2023;90(2):2567-73.
12. 12. Karthikeyan G, Renganathan G, Subashini R. Versatility and modifications of the cross-finger flap in hand reconstruction. International journal of scientific study. 2017; 5(6):35-46
13. 13. Voche P, Merle M. The homodigital subcutaneous flap for cover of dorsal finger defects. Br J Plast Surg. 1994;47:435-9.
14. 14. El-Khatib H. Adipofascial axial pattern cross-finger flap. Plast Reconstr Surg. 1996;97:850-3.
15. 15. Al-Qattan MM. The adipofascial turnover flap for coverage of the exposed distal interphalangeal joint of the fingers and interphalangeal joint of the thumb. J Hand Surg Am. 2001;26:1116-9.
16. 16. Shao X, Chen C, Zhang X, Yu Y, Ren D, Lu L. Coverage of fingertip defect using a dorsal island pedicle flap including both dorsal digital nerves. J Hand Surg Am. 2009;34:1474-81.
17. 17. Coşkunfirat OK, Velldedeoğlu HV, Bozdoğan N, Kurtay A, Demir Z. El Parmaklarindaki Yumuşak Doku Defektlerinin Onariminda Adipofasyal Ters Çevirme Flebi. Türk Plast Cer Derg. 1997;5(1).