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Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 8, pp 1171–1178 | Cite as

Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap

  • Annika Arsalan-WernerEmail author
  • Natallia Brui
  • Isabella Mehling
  • Michael Schlageter
  • Michael Sauerbier
Handsurgery
  • 40 Downloads

Abstract

Introduction

Fingertip injuries are frequent and several surgical strategies exist to reconstruct the amputated part and restore function and appearance. Yet, long-term results are rarely published. The purpose of this study was to examine the long-term clinical outcome of neurovascular island flaps for traumatic fingertip amputation of Allen type III/IV injuries.

Materials and methods

We retrospectively analysed a cohort of patients with traumatic fingertip amputation that underwent reconstruction with a neurovascular island flap from January 2003 to December 2014. No mandatory splinting was applied after surgery. 28 participants (29 fingers) were available for follow-up at mean 8 years after reconstruction. Activities of daily living were measured with the disabilities of the arm, shoulder and hand questionnaire. Grip strength and finger motion were assessed using a Jamar dynamometer and a goniometer. Two-point discrimination and Semmes–Weinstein monofilaments were used to evaluate sensory recovery.

Results

No intraoperative complications occurred and all flaps survived. Mean flap size was 4.7 ± 0.6 cm2. Active motion of the fingers was over 95% of the contralateral side at follow-up. Three patients showed mild extension lag of the proximal interphalangeal joint. The grip strength of the affected hand and of each of the affected fingers was over 70% of the contralateral side. In comparison to the contralateral side we did not detect any significant difference for the Semmes–Weinstein monofilament test, but two-point discrimination (5.1 ± 1.7 mm) was significantly impaired. According to the Lim classification 1 of 14 nails with hook nail deformity showed grade 3 breaking of the nail. The DASH score was 16.0. All patients returned to their original occupation and patient satisfaction with the procedure was high.

Conclusions

The risk for disabling flexion contracture seems to be small even without mandatory splinting. Neurovascular island flaps for fingertip amputation of Allen type III/IV injuries are a reliable tool in fingertip reconstruction in the long term.

Keywords

Fingertip defect Homodigital neurovascular island flap Homodigital artery flap Fingertip reconstruction Direct flow flap 

Notes

Acknowledgements

We thank our librarian Claudia Diemann-Paeth for helping with the literature research.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the regional State Chamber of Medicine (approval number FF 61/2016) and written informed consent was obtained from the participants indicating their permission to scientific publication of the data.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Annika Arsalan-Werner
    • 1
    Email author
  • Natallia Brui
    • 1
  • Isabella Mehling
    • 2
  • Michael Schlageter
    • 1
  • Michael Sauerbier
    • 1
  1. 1.Department for Plastic, Hand and Reconstructive Surgery, Hand Trauma CenterBG-Trauma Center Frankfurt am Main, Academic Hospital of the Johann Wolfgang Goethe-University Frankfurt Am MainFrankfurt am MainGermany
  2. 2.Division for Hand SurgerySt. Vinzenz Hospital HanauHanauGermany

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