The Role of Reversed Homodigital Island Flap in Digital Reconstruction

Hassan, Khaled

doi:10.21608/ejprs.2020.68223

The Role of Reversed Homodigital Island Flap in Digital Reconstruction

Document Type : Original Article

Author

Khaled Hassan

The Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Minia University, Egypt

10.21608/ejprs.2020.68223

Abstract

Background: Fingertip injuries are very common. Reconstruction
of extensive distal phalangeal defects with exposure
of tendon, bone, or joint can be particularly a difficult problem.
Options are local, regional and free flaps. SSG on bone and
tendon is unsuccessful and nondurable. The primary goals of
digital reconstruction are to preserve digital length and maintain
full mobility of the digit with providing adequate protective
cover of the deeper vital structures with soft tissue and skin
of good quality. Homodigital artery island flap has been found
to be very useful and is commonly used for the recon‌struction
of fingertip amputations.
Patients and Methods: We used the reversed homodigital
artery island flap to reconstruct fingertip injuries in 8 patients
at Minia University Hospital and private sector in the period
between January to December 2017. We retrospectively
analyzed patients for: Age, sex, mechanism of injury, location
of defect, flap survival, sensory recovery and donor site
coverage.
Results: Five patients were males and 3 females. Age
from 18 to 42 years mean (27.3 years). Six patients had
complete flap survival and two patients suffered venous
congestion that resolved completely by conservative measures.
Donor site closure was directly closed in all cases. Near
normal sensory recovery was noted.
Conclusion: The reverse homodigital island flap is a safe
method for distal phalangeal reconstruction offering multiple
advantages over other local, regional and free flaps with an
almost negligible donor site defect. Venous congestion and
inability to reconstruct proximal finger defects are drawbacks

Keywords

Homodigital flap – Reconstruction

Main Subjects

Hand and Upper Limb Surgery'

References

1- Gellman H.: Fingertip-nail bed injuries in children: Current
concepts and controversies of treatment. J. Craniofac.
Surg., 20: 1033-1035, 2009.
2- Hile D. and Hile L.: The emergent evaluation and treatment
of hand injuries. Emerg. Med. Clin. North. Am., 33: 397-
408, 2015.
3- Elliot D. and Yii W.: Homodigital reconstruction of the
digits: The perspective of one unit. Handchir. Mikrochir.
Plast. Chir., 33 (1): 7-19, 2001.
4- Aboulwafa A. and Emara S.: Versatility of Homodigital
Islandized Lateral VY Flap for Reconstruction of Fingertips
and Amputation Stumps. Egypt. J. Plast. Reconstr.
Surg., 37: 89-96, 2013.
5- Venkataswami R. and Subramanian N.: Oblique triangular
flap: A new method of repair for oblique amputation of
the fingertip and thumb. Plast. Reconstr. Surg., 66: 296-
300, 1980.
6- Kojima T., Tsuchida Y., Hirase Y., et al.: Reverse vascular
pedicle digital island flap. Br. J. Plast. Surg., 43: 290-
295, 1990.
7- Lemmon J.A., Janis J.E. and Rohrich R.J.: Soft-tissue
injuries of the fingertip: methods of evaluation and treatment.
An algorithmic approach. Plast. Reconstr. Surg.,
122: 105e-117e, 2008.
8- Ozaksar K, Toros T. and Sugun T.S.: Reconstruction of
finger pulp defects using homodigital dorsal middle
phalangeal neurovascular advancement flap. J. Hand.
Surg. Eur., 35: 125-129, 2010.
9- Iwasawa M., Kawamura T. and Nagai F.: Dorsally extended
digital island flap for repairing soft tissue injury of the
fingertip. J. Plast. Reconstr. Aesthet. Surg., 64: 1300-
1305, 2011.
10- Han S.K., Lee B.I. and Kim W.K.: The reverse digital
artery island flap: Clinical experience in 120 fingers.
Plast. Reconstr. Surg., 101: 1006-11, 1998.
11- Ishikawa K., Ogawa Y., Soeda H., et al.: A new classification
of the amputation level for the distal part of the
fingers. J. Jpn. Soc. Microsurg., 3: 54-62, 1990.
12- Momeni A., Zajonc H., Kalash Z., et al.: Reconstruction
of distal phalangeal injuries with the reverse homodigital
island flap. Injury, 39 (12): 1460-3, 2008.
13- Weeks P.M. and Wray R.C.: Management of acute hand
injuries: A biological approach. 2nd ed., St Louis: Mosby
Co., pp 140-143, 1973.
14- Lai C.S., Lin S.D., Chou C.K., et al.: Innervated reverse
digital artery flap through bilateral neurorrhaphy for pulp
defects. Br. J. Plast. Surg., 36: 483-488, 1993