Reverse Digital Island Flap with Skin Strip Retention to Prevent Flap Congestion

Jin Yong Shin; Mun-Young An; Si-Gyun Roh; Nae-Ho Lee; Kyung-Moo Yang

doi:10.12790/jkssh.2016.21.2.70

Journal List > J Korean Soc Surg Hand > v.21(2) > 1106550

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Shin, An, Roh, Lee, and Yang: Reverse Digital Island Flap with Skin Strip Retention to Prevent Flap Congestion

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(2):70-76.

Published online: 11 June 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.2.70

Reverse Digital Island Flap with Skin Strip Retention to Prevent Flap Congestion

Jin Yong Shin, Mun-Young An, Si-Gyun Roh, Nae-Ho Lee, Kyung-Moo Yang

Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, Jeonju, Korea

Correspondence to: Nae-Ho Lee, Department of Plastic and Reconstructive Surgery, Chonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea, TEL: +82-63-250-1860, FAX: +82-63-250-1866, E-mail: psjyshin@gmail.com

Received 4 April 20166 June 2016 Accepted 7 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The reverse digital island flap is useful for the repair of various fingertip injuries. We present a modified surgical technique with skin strip elevation for the prevention of postoperative congestion.

Methods:

From January 2005 to October 2015, we performed 31 reconstructive procedures for finger injury using a reverse digital artery island flap with and without skin strip retention. Patients’ clinical characteristics, surgical outcomes, and complications were investigated.

Results:

All flaps survived and there were no donor site problems. The mean follow-up time was 5 months (range, 3-8 months). In skin strip retention group, mild venous congestion was observed in 1 case, although it resolved spontaneously. Another case retained flexion contracture, and 2 patients had stiffness at the distal interphalangeal joint. Whereas, in no retention group, venous congestion was observed in 3 cases, 1 patient had partial flap necrosis and 2 patient suffer in flexion contracture at metacarpophalangeal joint.

Conclusion:

The reverse digital island flap procedure produces consistent results and is reliable for the treatment of fingertip injury. Our modified surgical technique of elevating the flap accompanied by skin strip retention helps prevent postoperative congestion.

Keywords: Fingertip injury, Reverse digital island flap, Prevention of congestion

REFERENCES

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Fig. 1.

A 61-year-old-male with posttraumatic amputation, the defect size was about 1.5×2.0 cm over the left thumb. (A) Reverse-flow heterodigital island flap with skin strip was elevated from index finger. (B) The flap with skin strip was transferred into the defect. (C) Five months after the operation, the flap circulation was intact.

Fig. 2.

Partial flap necrosis of reverse digital island flap in no skin retention group.

Table 1.

Patient data of the reverse digital island flap without skin strip retention

Case	Age (yr)	Sex	Cause	Lesion		Detach (day)
1	45	Male	Grinder	Rt	Ring	^*
2	40	Male	Milling machine	Rt	Little	^*
3	48	Female	Press	Rt	Ring	^*
4	28	Male	Grinder	Rt	Index	7
5	10	Female	Knife	Rt	Thumb	12
6	48	Male	Grinder	Lt	Middle	^*
7	47	Male	Grinder	Lt	Ring	15
8	25	Male	Milling machine	Lt	Ring	15
9	37	Female	Milling machine	Lt	Index	^*
10	50	Male	Press	Rt	Middle	^*
11	36	Male	Milling machine	Rt	Little	^*

Rt, right; Lt, left.

^* Homodigital island flap not needing flap detachment.

Table 2.

Patient data of postoperative complications without skin strip retention

Characteristic	Value
Mean age (yr)	37.63 (range, 10 to 50)
Male:female	8:3
Mean detach day	12.25 (range, 7 to 15)
Complication
Early
Flap necrosis	1
Venous congestion	3
Hemorrhage	0
Dehiscence	5
Delayed
DIP joint stiffness	0
Flexion contracture	2

DIP, digital island flap.

Table 3.

Patient data of the reverse digital island flap with skin strip retention

Case	Age (yr)	Sex	Cause	Lesion		Detach (day)
1	71	Male	Rope	Rt	Middle	14
2	57	Female	Press	Lt	Ring	^*
3	61	Male	Press	Lt	Thumb	8
4	44	Male	Grinder	Rt	Thumb	11
5	77	Female	Snake bite	Rt	Ring	11
6	38	Male	Press	Rt	Middle	^*
7	54	Male	Milling machine	Rt	Thumb	14
8	35	Male	Traffic accident	Rt	Thumb	10
9	84	Female	Snake bite	Rt	Index	13
10	36	Male	Press	Lt	Ring	11
11	57	Female	Knife	Lt	Thumb	12
12	67	Male	Snake bite	Lt	Index	^*
13	48	Female	Milling machine	Rt	Thumb & index	10
14	34	Male	Rope	Lt	Ring	14
15	37	Female	Press	Lt	Middle	^*
16	40	Male	Milling machine	Rt	Little	13
17	32	Male	Milling machine	Lt	Little	12
18	57	Male	Snake bite	Rt	Index	12
19	29	Male	Milling machine	Lt	Ring	13
20	19	Male	Press	Lt	Index	10

Rt, right; Lt, left.

^* Homodigital island flap not needing flap detachment.

Table 4.

Patient data of postoperative complications with skin strip retention

Characteristic	Value
Mean age (yr)	48.85 (range, 19 to 84)
Male:female	14:6
Mean detach day	11.75 (range, 8 to 14)
Complication
Early
Flap necrosis	0
Venous congestion	1
Hemorrhage	0
Dehiscence	1
Delayed
DIP joint stiffness	2
Flexion contracture	1

DIP, digital island flap.

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