Fingertip defects coverage using reverse-flow homodigital island flaps

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Abstract

BACKGROUND: The hand has always been a highly organized tool in human’s daily and professional activity. Distal phalanges are most commonly exposed to trauma, which often cause defects that need to be covered through plastic surgery. One of the most reliable and universal methods for fingertip reconstruction is the reverse-flow homodigital island flap.

CLINICAL CASES: This series of clinical cases describe three children aged 7, 8, and 11 years who underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In all cases, mechanisms of injury were associated with crushing and rupture of soft tissues. All children underwent coverage of fingertip defects with the reverse-flow homodigital island flap. In the first case, evaluation results at 6 months after surgery revealed 4 mm in the Weber’s test and phalanx length deficit of 2 mm. In the second case, the assessment performed 1 month after surgery revealed 5 mm in the Weber’s test and the length of the operated phalanx corresponds to the contralateral one. In the third case, results of the 2-month observation period revealed 4 mm in the Weber’s test and lengths of the operated and contralateral phalanges were the same.

DISCUSSION: The reverse-flow homodigital island flaps have irrefragable advantages among methods of surgical reconstruction of soft tissues of distal phalanges. These are single-stage reconstruction techniques that can possibly replenish sufficient amounts of soft tissues to the defect. A literature data analysis of the outcomes of the fingertip reconstruction through the reverse-flow homodigital island flaps revealed good and satisfactory results.

CONCLUSIONS: The method of the reverse-flow homodigital island flap has potential to take a significant place in pediatric traumatology and reconstructive surgery.

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About the authors

Alexander V. Alexandrov

Filatov Moscow Children’s Clinical Hospital

Email: alexmicrosurg@mail.ru
ORCID iD: 0000-0002-6110-2380
SPIN-code: 5229-0038
Russian Federation, Moscow

Alexander A. Smirnov

Filatov Moscow Children’s Clinical Hospital; Russian National Research Medical University

Email: smirnov_aan@bk.ru
ORCID iD: 0000-0002-7274-8291

MD, PhD student

Russian Federation, Moscow; Moscow

Pavel V. Gonchruk

Filatov Moscow Children’s Clinical Hospital; Russian National Research Medical University

Author for correspondence.
Email: goncharukpavel@yandex.ru
ORCID iD: 0000-0002-9560-037X
Russian Federation, Moscow; Moscow

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2. Fig. 2. Allen classification of defects of the nail phalanges of the fingers

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3. Fig. 3. Schematic representation of the nail phalanx defect closure with a reverse-flow homodigital island flap

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4. Fig. 1. An 8-year-old female patient. Distal part avulsion of the nail phalanx of finger II of the right hand: a — soft tissue defect; b — radiographs of the finger II of the right hand upon hospital admission; c — defect closure; d — finger view 6 months after the surgery

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5. Fig. 4. An 11-year-old female patient. Soft tissue avulsion of the distal phalanx of finger IV of the left hand: a — lateral oblique defect of soft tissues; b — radiographs of the finger IV of the left hand; c — finger appearance 2 months after the surgery

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6. Fig. 5. A 7-year-old male patient. Soft tissue avulsion of the nail phalanx of finger III of the right hand: a — transverse defect of soft tissues; b — radiographs of finger III of the right hand; c — appearance 1 month after the surgery

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Copyright (c) 2021 Alexandrov A.V., Smirnov A.A., Gonchruk P.V.

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