Department of Plastic and Reconstructive Surgery, Nagano Red Cross Hospital, Wakasato 5-22-1, Nagano 380-8582, Japan.
J Plast Reconstr Aesthet Surg. 2011 Oct;64(10):1300-5. doi: 10.1016/j.bjps.2011.04.026. Epub 2011 Jul 7.
The digital triangular island flap is one of the most useful types of flap for repairing soft-tissue loss at the fingertip, because it is sensate and has glabrous skin. However, this type of flap has several disadvantages, including limited length of advancement and limited flap size.
We have developed a new type of dorsally extended digital island flap to extend the reach of the digital triangular island flap. This dorsally extended portion, 15 mm in width and 20 mm in length, is based on the dorsal branch of the digital artery at the distal phalanx level. This island flap has a longer reach than the conventional digital island flap and can transfer larger amounts of soft tissue to the injured fingertip. Sixteen patients with fingertip amputation were treated using this flap.
All of the flaps survived. The dorsally extended digital island flap could repair pulp tissue losses up to 30 mm in length in oblique volar injury. In transverse injury, a new fingertip could be produced with this flap in a single stage. We successfully covered the exposed bone without shortening the digital bone of the fingertip using our extended flap. No claw nail deformity occurred and no flexion contracture remained in any of the cases.
Use of a dorsally extended digital island flap is recommended for repairing fingertip injury in cases with defect sizes ranging from 10 to 30 mm in length and also in both oblique volar and transverse injuries. This flap is more versatile for repair of fingertip injury than the conventional digital island flap.
指蹼三角岛状皮瓣是修复指尖软组织缺损最常用的皮瓣类型之一，因为它具有感觉功能且皮肤无毛。然而，这种皮瓣有几个缺点，包括推进长度有限和皮瓣尺寸受限。
我们开发了一种新型的背侧延伸指岛状皮瓣，以扩大指蹼三角岛状皮瓣的覆盖范围。这个背侧延伸部分宽15毫米、长20毫米，以远端指骨水平的指动脉背支为蒂。这种岛状皮瓣比传统指岛状皮瓣的覆盖范围更长，能向受伤指尖转移更多的软组织。16例指尖离断患者接受了该皮瓣治疗。
所有皮瓣均存活。在掌侧斜形损伤中，背侧延伸指岛状皮瓣可修复长达30毫米的指腹组织缺损。在横行损伤中，用该皮瓣可一期再造新的指尖。我们用延伸皮瓣成功覆盖了外露骨质，且未缩短指尖指骨。所有病例均未出现爪形甲畸形，也没有残留屈曲挛缩。
对于长度在10至30毫米的缺损病例，以及掌侧斜形和横行损伤的指尖损伤修复，建议使用背侧延伸指岛状皮瓣。与传统指岛状皮瓣相比，这种皮瓣在修复指尖损伤方面更具通用性。
