Is the cross-finger flap a good option at the extensor zone defect?

Abstract

Objectives: This study aims to evaluate the surgical and clinical outcomes of reversed cross-finger subcutaneous flaps applied to patients with dorsal digital defects.

Patients and methods: Between January 2015 and September 2018, 25 (22 males, 3 females; mean age 35.6±11.6 years; range, 19 to 65 years) out of 27 patients under prospective follow-up with finger dorsal digital defect were retrospectively screened and included in the study. The data, obtained by the same two surgeons at six months postoperatively in patients who had undergone reversed cross-finger subcutaneous flaps surgery, concerned cold intolerance, a static two-point separation test, and functional results using range of motion (ROM) and Quick Disabilities of the Arm, Shoulder and Hand (DASH) scoring.

Results: The majority of the patients presented with occupational injury (64%), most commonly to the dominant hand (76%) and the fourth finger (36%) most frequently. Seven patients with extensor tendon defects underwent reconstruction with a palmaris longus autograft. At the six-week postoperative follow-up, all flaps were live, the donor site had no morbidity, and no additional intervention was performed. There was no statistically significant difference in finger joint ROM (p>0.05). Cold intolerance was observed in 14 patients (56%). The mean dynamic two-point distinction was 6.0±0.7 mm and the QuickDASH score was 22.3±5.0.

Conclusion: Due to reasons such as minimal donor site morbidity, satisfactory functional finger outcomes, and easy applicability, reversed cross-finger subcutaneous flap is a good option for reconstruction of defects in the dorsal aspect of the finger with or without extensor mechanism defects.

Figure 1. Schematic drawing of surgical technique. (a) Dorsal digital defect. (b) Reconstruction of extensor mechanism with musculus palmaris longus tendon autografting. (c) A split-thickness skin flap with intact subdermal vascular plexus elevation. (d) Covering of defect with a reversed full-thickness subcutaneous flap. (e) Covering of reversed full-thickness subcutaneous flap with a split-thickness skin graft. (f) Flap separation.

Figure 2. Clinical presentation of surgical technique by selected two cases. (a) View of defect including extensor mechanism after surgical debridement. (b) Reconstruction of extensor mechanism with musculus palmaris longus tendon autografting. (c) Elevation of thin full-thickness skin flap at donor finger dorsal side. (d) Elevation of full-thickness subcutaneous flap with an intact skin island. (e) Reversed full-thickness subcutaneous flap covering recipient defect. (f) Skin grafting covering reversed surface of reversed cross-finger subcutaneous flaps. (g) Early postoperative view of donor and recipient fingers after first operation. (h) Preoperative view of donor and recipient fingers before second operation. (i) Early postoperative view of donor and recipient fingers after second operation. (j, k and l) Final clinical views of donor and recipient fingers at six months. * Elevated skin flap; ** Elevated and first sutured subcutaneous flap; *** All figures show two cases to emphasize steps of surgical technique.