Yazar Mehmet, Aydın Atakan, Kurt Yazar Sevgi, Başaran Karaca, Güven Erdem
İstanbul University, İstanbul Faculty of Medicine, Department of Plastic and Reconstructive Surgery, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2010;44(5):345-51. doi: 10.3944/AOTT.2010.2351.
The location of the fingertip entitles it to have significant cosmetic and functional values, but also places it at high risk for injury. During repair, finger length and function should be maintained, and stiffness and neuroma should be avoided. Various flaps have been described for reconstruction of distal finger defects with bone, tendon, or joint exposures, including reverse flow homodigital island flap. In this study, we present our experience of reverse flow homodigital island flap in terms of sensory recovery.
Sixty-six patients (70 fingers) with fingertip amputations were included in the study. Patients were treated with homodigital island flaps. All patients underwent sensitivity assessment by 2-point discrimination and Semmes-Weinstein monofilament tests at 6, 12, and 18 months during follow-up, and complications were recorded.
Monofilament testing results were normal in 64 fingers (91.4%), and diminished light touch was found in six fingers. Two-point discrimination results were normal (<6 mm) in 40 fingers and fair (6-10 mm) in 30 fingers (mean 5.7 mm, range 4-9 mm). Complications included one partial flap necrosis, three flexion contractures, and two neuromas.
In repair of injuries to areas in which sensory feedback is critical, such as the index finger, the homodigital flap may be the treatment of choice.
指尖的位置使其具有重要的美容和功能价值，但也使其处于高损伤风险中。在修复过程中，应保持手指长度和功能，避免僵硬和神经瘤形成。已经描述了多种用于重建伴有骨、肌腱或关节外露的手指远端缺损的皮瓣，包括逆行同指岛状皮瓣。在本研究中，我们介绍了逆行同指岛状皮瓣在感觉恢复方面的经验。
本研究纳入了66例（70指）指尖离断患者。患者采用同指岛状皮瓣治疗。所有患者在随访期间的6个月、12个月和18个月时通过两点辨别觉和Semmes-Weinstein单丝试验进行感觉评估，并记录并发症。
64指（91.4%）单丝试验结果正常，6指发现轻触觉减退。40指两点辨别觉结果正常（<6mm），30指结果尚可（6 - 10mm）（平均5.7mm，范围4 - 9mm）。并发症包括1例部分皮瓣坏死、3例屈曲挛缩和2例神经瘤。
在修复感觉反馈至关重要的区域（如示指）的损伤时，同指皮瓣可能是首选治疗方法。
