Neurovascular Heterodigital Island Flap for Digital Pulp Defect Reconstruction: 58 Case Series

Year 2023, Volume: 7 Issue: 3, 259 - 262, 31.12.2023

Muhsin Dursun

https://doi.org/10.30565/medalanya.1397435

Abstract

Aim: Our study aims to report the neurovascular heterodigital island flap reconstruction for finger pulp defects.

Patients and Methods: This study included 58 patients presenting to our clinic with pulp defects between 2014 and 2022. The average age of the patients was 26 years (20 - 56 years). Injuries were Allen type 2 for 18 patients, type 3 for 33 patients, and type 4 for 7 patients. Pulp defects were caused by crush injury (n:42) and sharps injury (n:16).

Results: None of the flaps administered to the participating patients developed any total loss. Three patients developed partial loss in the distal flap. Six patients were found to have superficial tissue infection. Two patients were found to have hyperpigmentation and hyperesthesia. While one patient with Allen type 3 pulp defect was detected to have 10 degrees of flexion contracture in the distal interphalangeal (DIP) joint and 5 degrees of flexion contracture in the proximal interphalangeal joint, three patients were found to have 5 degrees of flexion contracture only in the DIP joint. The mean static two-point discrimination of the pulp-administered flap was 5.2 mm (3-8 mm) and on the contralateral side was 3 mm. The mean Semmes-Weinstein monofilament test was 3.18 g (2.96 – 4.7 g) in the pulp administered flap and 2.92 g in the contralateral side.

Conclusions: Reconstruction of pulp defects with neurovascular heterodigital island flap is a reliable treatment option with satisfactory functional and sensory outcomes.

Keywords

hand trauma, fingertip reconstruction, heterodigital island flap, local arterialized flap.

Parmak Pulpa Defektlerinin Nörovasküler Heterodijital Ada Flebi ile Rekonstrüksiyonu: 58 Vakalık Seri

Abstract

Amaç: Çalışmamızın amacı el parmak pulpa defekti olan hastalarda nörovasküler heterodijital ada flebi ile pulpa rekonstrüksiyonu sonuçlarımızı bildirmektir.

Patients ve Metod: Kliniğimize 2014-2022 yılları arasında pulpa defekti ile başvuran 58 hasta (42 erkek, 16 kadın) çalışmaya dahil edilmiştir. Hastaların yaş ortalaması 26’dır (20-56 yaş). Hastaların 18 tanesi Allen tip 2, 33 tanesi Allen tip 3 ve 7 tanesi Allen tip 4 yaralanmalardı. Pulpa defektleri crush yaralanma (n:42) ve kesici alet yaralanması (n:16) ile meydana gelmişti.

Bulgular: Çalışmaya dahil edilen hastalara uygulanan fleplerin hiçbirisinde total kayıp gelişmemiştir. Üç hastada flep distalinde kısmi kayıp gelişti. Hastaların 6 tanesinde yüzeyel doku enfeksiyonu görüldü. Donör saha morbiditesi olarak 2 hastada hiperpigmentasyon ile birlikte günlük hayatını etkilemeyecek şekilde hiperestezi tespit edildi. Allen tip 3 pulpa defektli olan 1 hastada distal IP (interphalangeal) eklemde 10 derece fleksiyon kontraktürü ile birlikte PIP eklemde 5 derece fleksiyon kontraktürü tespit edilirken, 3 hastada sadece distal IP eklemde 5 derece fleksiyon kontraktürü tespit edildi. Flep uygulanmış olan pulpaların ortalama statik 2 nokta diskriminasyonu 5,2 mm (3-8 mm) iken karşı tarafta ortalama 3 mm idi. Ortalama Semmes-Weinstein monofilament testleri flep uygulanmış olan pulpada 3.18 g (2.96 – 4.7 g) iken karşı tarafta 2.92 g idi.

Sonuç: Akut el yaralanmaları sonrası oluşan pulpa defektlerinin nörovasküler heterodijital ada flebi ile rekonstrüksiyonu fonksiyonel, estetik ve duyusal anlamda tatminkar sonuçlara sahiptir.

Keywords

el travması, parmak ucu replantasyonu, fingertip reconstruction, heterodigital ada flebi, local arterli flep.

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