Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap

Abstract

Background: This study aimed to compare the outcomes of reverse digital artery island flap (RDAIF) in primary and secondary reconstruction after failed replantation or composite graft method.

Methods: This study retrospectively analyzed 42 patients that underwent RDAIF (18 primary and 24 secondary). Preoperative details (demographics, injury details, and waiting days) and postoperative outcomes (active arc of proximal interphalangeal [PIP] and distal interphalangeal (DIP) joints, extension loss of PIP, flexion arc of metacarpophalangeal joint, total active motion, flap sensation, the presence of numbness, Tinel's sign and cold intolerance) were evaluated. Quick Disabilities of the Arm, Shoulder, and Hand score (Quick-DASH) and patient satisfaction were also statistically compared between the 2 groups.

Results: There was no significant difference in patient demographics between the 2 groups in sex, age, smoking and diabetic history, affected hand and finger, injury type and level, and flap area. The only difference was in waiting days. Similar sensory recovery and patient satisfaction were found in both groups. Range of motion in the DIP and PIP joints, extension loss of PIP, total active motion, and Quick-DASH were superior in the primary coverage group. Increasing age, subzone III injury, and secondary reconstruction were found to be the factors that adversely affected the postoperative range of motion.

Conclusions: Secondary reconstruction was more likely to result in joint contracture. In the event of a damaged fingertip amputation in older patients, primary flap reconstruction should be considered as the initial treatment of choice, with regard to the ultimate range of motion.

Keywords: fingertip injury; fingertip reconstruction; homodigital artery flap; reverse digital artery island flap.

Figure 1.

Immediate reconstruction for a 58-year-old male patient who sustained a cut injury to his left ring finger due to machinery operation. Note. (a) 2.0 cm × 1.3 cm flap was designed at the ulnar base of the proximal phalanx. (b) Flap elevation preserving the proper digital nerve. (c) Fingertip coverage at the end of surgery. (d) Appearance at 12 months after primary surgery.

Figure 2.

Secondary reconstruction for a 40-year-old female patient who sustained a crush injury to her right ring finger with broken wood. Note. (a) Fingertip necrosis after failed replantation. (b) A 2.6 cm × 1.8 cm flap design with skin paddle after debridement. (c) Flap elevation. (d) Flap inset and wound closure. (e) Appearance at 23 months after salvage surgery.