Abstract
Introduction
The reverse homodigital dorsoradial flap remains a useful alternative for covering thumb defects. However, the description of pedicle width of dorsoradial flap is not clear. The aim of this study was to compare the results of narrow pedicle with wide pedicle in dorsoradial flaps and describe our experience with the thumb reconstruction.
Materials and methods
From July 2014 to February 2019, 42 patients were treated with the reverse dorsoradial flap for thumb reconstruction. The patients were divided as Group A (pedicle width ≤ 0.8 cm) and Group B (pedicle width > 0.8 cm). Flap survival, time to return to work, flap sensibility, the range of motion (ROM) of the joints, and final aesthetic outcomes were evaluated.
Results
Respectively in the Group A (17 cases) and Group B (25 cases), 14–19 flaps survived uneventfully, whereas 3–6 flaps experienced venous congestion with no or partial flap loss. No significant difference was identified between the two groups for the incidence of venous congestion, static 2-point discrimination and ROM of the injured thumbs. Time to return to work was significantly shorter in Group A. The aesthetic satisfaction of the patients in Group A was significantly better comparing with that in Group B.
Conclusions
The reverse homodigital dorsoradial flap with narrow pedicle width is associated with more favorable outcomes in terms of time lost from work and aesthetic satisfaction of the patients.
Similar content being viewed by others
References
Heitmann C, Levin LS (2002) Alternatives to thumb replantation. Plast Reconstr Surg 110(6):1492–1503
Eberlin KR, Chang J, Curtin CM, Sammer DM, Saint-Cyr M, Taghinia AH (2014) Soft-tissue coverage of the hand: a case-based approach. Plast Reconstr Surg 133(1):91–101
Demiri EC, Dionyssiou DD, Pavlidis LC, Papas AV, Kostogloudis NH, Lykoudis EG (2013) Soft tissue reconstruction of the thumb with the dorsoradial forearm flap. J Hand Surg Eur 38:412–417
Moschella F, Cordova A, Pirrello R, Brunelli F (1996) Anatomic basis for the dorsal radial flap of the thumb: clinical applications. Surg Radiol Anat 18(3):179–181
Brunelli F, Vigasio A, Valenti P, Brunelli GR (1999) Arterial anatomy and clinical application of the dorsoulnar flap of the thumb. J Hand Surg Am 24(4):803–811
Prakash V, Chawla S (2004) First dorsal metacarpal artery adipofascial flap for a dorsal defect of the thumb. Plast Reconstr Surg 114(5):1353–1355
Foucher G, Braun JB (1979) A new island flap transfer from the dorsum of the index to the thumb. Plast Reconstr Surg 63(3):344–349
Cheng G, Fang G, Hou S et al (2007) Aesthetic reconstruction of thumb or finger partial defect with trimmed-toe flap. Microsurgery 27:74–83
Hrabowski M, Kloeters O, Germann G (2010) Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique. J Hand Surg 35(4):659–662
Sun YC, Gong YP, Chen QZ (2015) A reverse dorsoradial pedicled flap from the thumb for a soft tissue defect in the finger. J Hand Surg Eur 40(9):1000–1001
Moschella F, Cordova A (2006) Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg 117(3):920–926
Qin H, Kong J, Xu L, Wang H, Ma N, Xia J (2019) The width of pedicle included in reverse dorsoradial flap of the thumb: as wide as possible? J Plast Reconstr Aesthet Surg 72(12):2067–2069
Allen IE, Seaman CA (2007) Likert scales and data analyses. Qual Prog 40(7):64–65
Rehim SA, Chung KC (2014) Local flaps of the hand. Hand Clin 30(2):137–151
Jindal R, Schultz BE, Ruane EJ, Spiess AM (2016) Cadaveric study of a Z-plasty modification to the Moberg flap for increased advancement and decreased morbidity. Plast Reconstr Surg 137(3):897–904
Adani R, Mugnai R, Petrella G (2019) Reconstruction of traumatic dorsal loss of the thumb: four different surgical approaches. Hand (NY) 14(2):223–229
Jiao H, Ding X, Liu Y, Zhang H, Cao X (2015) Clinical experience of multiple flaps for the reconstruction of dorsal digital defects. Int J Clin Exp Med 8(10):18058–18065
Checcucci G, Galeano M, Zucchini M, Zampetti PG, Ceruso M (2014) Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb. Microsurgery 34(4):283–286
Zhang X, Shao X, Ren C, Zhang Z, Wen S, Sun J (2011) Reconstruction of thumb pulp defects using a modified kite flap. J Hand Surg Am 36(10):1597–1603
Chi Z, Lin D, Chen Y et al (2018) Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal metacarpal artery flap. J Plast Reconstr Aesthet Surg 71(6):870–875
Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F (2014) Repair and reconstruction of thumb and finger tip injuries : a global view. Clin Plast Surg 41(3):325–359
Germann G, Rudolf KD, Levin SL, Hrabowski M (2017) Fingertip and thumb tip wounds: changing algorithms for sensation, aesthetics, and function. J Hand Surg Am 42(4):274–284
Sun YC, Chen QZ, Chen J, Gong YP, Gu JH (2015) Reverse dorsoradial flaps for thumb coverage show increased sensory recovery with smaller flap sizes. J Reconstr Microsurg 31(6):426–433
Chen C, Tang P, Zhang X (2014) The dorsal homodigital island flap based on the dorsal branch of the digital artery: a review of 166 Cases. Plast Reconstr Surg 133(4):519e–529e
Zhang X, Shao X, Zhu M, Jiang R, Feng Y, Ren C (2013) Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx. J Hand Surg Eur 38(4):378–385
Ramírez AR, Gonzalez SM (2012) Arteries of the thumb: description of anatomical variations and review of the literature. Plast Reconstr Surg 129(3):468e–476e
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Author information
Authors and Affiliations
Contributions
All the named authors were actively involved in the planning, enactment, and writing up of the study.
Corresponding author
Ethics declarations
Conflicts of interest
The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical approval
The study protocol was approved by the Human Research Ethics Committee of the Yijishan Hospital of Wannan Medical College.
Informed consent
Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Qin, H., Ma, T., Xia, J. et al. Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle. Arch Orthop Trauma Surg 140, 987–992 (2020). https://doi.org/10.1007/s00402-020-03467-7
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-020-03467-7