Article
The use of modified Kutler method for the treatment of amputation of the fingertip
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Authors
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Hideyuki Mizushima
- Orthopedic Surgery, Sakai City Medical Center, Sakai City, Osaka, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Replantation cannot be performed in all cases of fingertip amputation, and in such cases, a pedicle flap is sometimes used to cover the skin and soft tissue defect. Kutler described a technique of bilateral V-Y advancement flap for reconstructing fingertip amputation in 1947. In this study, we show an newly developed bilateral V-Y advancement flap (modified Kutler method) and evaluated the outcomes of this local flap.
Materials: We reviewed 21 cases (men, 21; women, 1; average age, 47 years) of amputation of the fingertip from July 2009 to February 2016. The injury sites were as follows: thumb (1), index finger (6), middle finger (7), ring finger (4), and little finger (3). Nineteen cases were injured in crush, and 2 were in clean cut. The average follow-up period was 188 weeks. Sensory disturbance and pain were examined at the final follow-up.
Methods: Inverted triangular flaps, the apex of those were placed on distal interphalangeal joint, were designed in radial and ulnar side of amputated finger. The volar incision was slightly undermined but left attached to subcutaneous tissue, and the dorsal incision was made to periosteum in both flaps. Both dorsal incisions were connected anterior to distal phalanx and volar subcutaneous tissue which include two flaps was separated from distal phalanx. Because of this maneuver, mobility of both flaps was greater than original Kutler method.
Results: All flaps survived. numbness, hypersensitivity, or hypesthesia remained in 8, 5 and 10 cases respectively. And pain due to an attack remained in 1 case. Coldness remained in 5 cases. Affected finger were useful in 18 patients and not useful in 3 patients. Of three cases, one was not useful because of pain, one was of hypersensitivity, and remained one was of hypesthesia.
Summary: Our modification allowed much greater mobility of the bilateral V-Y advancement flap than original Kutler method. But in this study, the incidence of numbness, hypersensitivity, or hypesthesia after operasion were higher than expected. Otherwise, this flap is very useful method for fingertip injury because affected fingers were useful in most of patients.
