gms | German Medical Science

Objectives/Interrogation: The fingertip is a highly specialized structure, with prehensile and tactile functions that can be importantly reduced after an injury. The goal of the treatment of this injuries is to maintain the length, sensitivity and mobility of the finger, with a painless and padded stump.

There are many techniques described to treat these lesions, from simple regularization or v-y local flaps, through homodigital neurovascular flaps, to heterodigital, thenar or other flap alternatives.

The aim of this study is to compare clinical and functional outcomes of two surgical techniques: homodigital direct flow flaps (DFF) and homodigital reverse flow island flaps (RFF) to cover fingertip injuries in tri-phalangeal fingers performed between 2012 and 2018 in a workers insurance trauma center.

Methods: We reviewed the operative protocols performed between April 2012 and April 2018 by the hand surgeons of our institution and selected those who described homodigital neurovascular flaps to cover fingertip injuries.

Epidemiological data were collected, such as age, gender, laterality, finger involved and mechanism of injury.

The cases were classified by Allen's level of amputation, direction of injury [1], type of intervention (primary or secondary) and type of flap performed (DFF or RFF).

The outcomes we measured were time to labor, functional results (range of finger motion, strength, two points discrimination and sensibility) and the presence of complications and reinterventions.

Results and Conclusions: We obtained 43 cases, 92% of these were men, 77% were by crushing and 53% on the right hand.

The most frequent fingers involved were index (40%) and middle finger (35%). The most frequent diagnosis was amputation (62%) in a palmar oblique coronal direction (60%). The most frequent Allen's levels were II (42%) and I (37%). These data are consistent with the literature.

In 53% of cases a RFF was performed and in 47% it was a DFF. There were no epidemiological or functional differences between these groups.

Time to labor was 4.1 months in the DFF group and 5.4 months in the RFF group*.

A 41% of complications were observed; the most frequent ones were retractable scar (14%) and flap necrosis (11%).

The presence of complications was 3.4 times higher in the RFF group* and this group required 7 times more interventions*.

Based on ours results, we dare to recommend the DFF, since they are simpler to perform and have less complications, reinterventions and recovery time.

(*These differences were statistically significant.)