Karjalainen T, Sebastin S J, Chee K G, Peng Y P, Chong A K S
* Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
† Department of Hand and Reconstructive Microsurgery, Singapore University Hospital, Singapore.
J Hand Surg Asian Pac Vol. 2019 Mar;24(1):24-29. doi: 10.1142/S242483551950005X.
Local flaps are widely used to cover fingertip defects. Errors in design or technical execution of the flap may lead to morbidity and additional surgical procedure. The purpose of this study was to review flap related complications requiring unplanned secondary surgery to characterize preventable issues.
851 local flaps were used to reconstruct fingertip defects during a 9-year period. Patients requiring unplanned secondary surgery to address flap related complications were subjected to analysis.
31 of 851 flaps (3.6%) required unplanned secondary surgery because of flap related complications. The most reliable flap was VY advancement flap with only one (0.3%) re-operation. The reverse vascular island flap, cross finger flap, and neurovascular island flap were associated with the comparable number of complications (8.0%; 6.3%; and 3.8% respectively). Total or partial necrosis was the cause for re-operation in 6 patients (0.7%). The typical reason for secondary surgery was inadequate soft tissue cover of the tip with homodigital neurovascular island flap and flexion contracture with reverse vascular island flap. Cross finger flaps were revised because of poor graft take at the donor site, bulky flap or flap necrosis.
Local flaps are reliable operations to cover fingertip defects. Each flap has potential pitfalls, which may be avoided if the surgeon is aware of them.
局部皮瓣广泛用于覆盖指尖缺损。皮瓣设计或技术操作失误可能导致并发症及额外的手术。本研究旨在回顾因皮瓣相关并发症而需要进行非计划二次手术的情况，以明确可预防的问题。
在9年期间，851例局部皮瓣用于重建指尖缺损。对因皮瓣相关并发症而需要进行非计划二次手术的患者进行分析。
851例皮瓣中有31例（3.6%）因皮瓣相关并发症而需要进行非计划二次手术。最可靠的皮瓣是V-Y推进皮瓣，仅有1例（0.3%）再次手术。逆行血管岛状皮瓣、邻指皮瓣和神经血管岛状皮瓣的并发症数量相当（分别为8.0%、6.3%和3.8%）。6例患者（0.7%）再次手术的原因是皮瓣全部或部分坏死。二次手术的典型原因是同指神经血管岛状皮瓣对指尖软组织覆盖不足，以及逆行血管岛状皮瓣导致的屈曲挛缩。邻指皮瓣因供区植皮成活不佳、皮瓣臃肿或皮瓣坏死而进行修正。
局部皮瓣是覆盖指尖缺损的可靠手术方法。每种皮瓣都有潜在的陷阱，如果外科医生了解这些情况，就可以避免。
