Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap

Abstract

Purpose: To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer.

Methods: Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance, and time required for wound healing. Univariate and multivariate linear regression analyses were performed to identify the extent to which these variables affected the flexion contracture of the PIP joint.

Results: The average reduction in the passive extension angle of the PIP joint was 16° at final follow-up. Univariate analysis indicated significant correlations of PIP joint flexion contracture with age, injured finger, and time for wound healing, but no significant correlation with the distance the flap was advanced. Multivariate analysis indicated that the age and duration of wound healing were independent predictors of the flexion contracture of the PIP joint.

Conclusions: Elderly people and cases with delayed wound healing are at risk for postoperative PIP joint contracture after homodigital flap transfer. Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing.

Type of study/level of evidence: Prognostic II.

Keywords: Homodigital island flap; advancement flap; flexion contracture; predictor; proximal interphalangeal joint.