Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle

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.

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References

  1. 1.

    Heitmann C, Levin LS (2002) Alternatives to thumb replantation. Plast Reconstr Surg 110(6):1492–1503

    PubMed  Google Scholar 

  2. 2.

    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

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    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

    CAS  Article  Google Scholar 

  4. 4.

    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

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    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

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    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

    PubMed  Article  Google Scholar 

  7. 7.

    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

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    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

    PubMed  Article  Google Scholar 

  9. 9.

    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

    Article  Google Scholar 

  10. 10.

    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

    CAS  Article  Google Scholar 

  11. 11.

    Moschella F, Cordova A (2006) Reverse homodigital dorsal radial flap of the thumb. Plast Reconstr Surg 117(3):920–926

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    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

    Article  Google Scholar 

  13. 13.

    Allen IE, Seaman CA (2007) Likert scales and data analyses. Qual Prog 40(7):64–65

    Google Scholar 

  14. 14.

    Rehim SA, Chung KC (2014) Local flaps of the hand. Hand Clin 30(2):137–151

    PubMed  Article  Google Scholar 

  15. 15.

    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

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    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

    Article  Google Scholar 

  17. 17.

    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

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    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

    PubMed  Article  Google Scholar 

  19. 19.

    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

    PubMed  Article  Google Scholar 

  20. 20.

    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

    PubMed  Article  Google Scholar 

  21. 21.

    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

    PubMed  Article  Google Scholar 

  22. 22.

    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

    PubMed  Article  Google Scholar 

  23. 23.

    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

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    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

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    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

    CAS  Article  Google Scholar 

  26. 26.

    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

    PubMed  Article  Google Scholar 

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The author(s) received no financial support for the research, authorship, and/or publication of this article.

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All the named authors were actively involved in the planning, enactment, and writing up of the study.

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Correspondence to Wenxian Zhang.

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The study protocol was approved by the Human Research Ethics Committee of the Yijishan Hospital of Wannan Medical College.

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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

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Keywords

  • Thumb
  • Reverse flap
  • Venous congestion
  • Pedicle
  • Width