Gurbuz K, Dogar F, Yontar Y
Department of Orthopedics and Traumatology, Education and Research Hospital, Kayseri, Turkey.
Department of Orthopedics and Traumatology, Kayseri City Education and Training Hospital, Kocasinan, 38210 Kayseri, Turkey.
Indian J Orthop. 2022 Feb 3;56(5):847-855. doi: 10.1007/s43465-022-00605-8. eCollection 2022 May.
The fundamentals of fingertip defect reconstructions should be mainly to restore the sensation with contour and identical pulp volume, and texture. To achieve these, various flap techniques were described in which those had their own advantages and disadvantages to restore the fingertip injuries. This study aimed to compare clinical outcomes of three different local flap procedures widely used for the reconstruction of fingertip defects: heterodigital neurovascular island (HeNI) flap, reverse homodigital neurovascular island (rHoNI) flap, and cross-finger (CF) flap.
Between 2014 and 2019, statistical analysis of 58 patients undergoing reconstruction of fingertip defects of 2-5 digits by HeNI flap ( = 16), rHoNI flap ( = 17), or CF flap ( = 25), was performed retrospectively. All cases were reviewed regarding age, gender, etiology of trauma, duration of follow-up, the extent of the injury with the classification system PNB, Quick Disability of Arm, Shoulder, and Hand score (Q-DASH), cold intolerance symptom severity score (CISS), static 2-point discrimination test, ROM value of phalangeal joints and time to return to work.
The mean age of all patients was 36.9 years with a male-to-female ratio of 5.4:1 and a mean follow-up of 26.72 months. The most common cause was work-related ( = 41). The mean of DASH score, CISS score, static 2-point discrimination, time to return to work, and ROM value of DIP joint did not significantly differ between the study groups. The mean ROM values of PIP and MCP joints of patients for CF flaps applied were significantly lower than HeNI flaps.
The use of HeNI flap for fingertip reconstruction is a reliable one-stage option in terms of improved ROM of finger joints.
指尖缺损重建的基本原则应主要是恢复感觉、外形轮廓、相同的指腹体积和质地。为实现这些目标，人们描述了各种皮瓣技术，这些技术在修复指尖损伤方面各有优缺点。本研究旨在比较广泛用于重建指尖缺损的三种不同局部皮瓣手术的临床效果：异体神经血管岛状（HeNI）皮瓣、逆行同体神经血管岛状（rHoNI）皮瓣和交指（CF）皮瓣。
对2014年至2019年间58例行2 - 5指指尖缺损重建的患者进行回顾性统计分析，其中采用HeNI皮瓣（n = 16）、rHoNI皮瓣（n = 17）或CF皮瓣（n = 25）。回顾所有病例的年龄、性别、创伤病因、随访时间、采用PNB分类系统评估的损伤程度、手臂、肩部和手部快速残疾评分（Q - DASH）、冷不耐受症状严重程度评分（CISS）、静态两点辨别试验、指骨关节活动度（ROM）值以及恢复工作时间。
所有患者的平均年龄为36.9岁，男女比例为5.4∶1，平均随访时间为26.72个月。最常见的病因是与工作相关（n = 41）。各研究组之间的DASH评分、CISS评分、静态两点辨别、恢复工作时间和远侧指间关节（DIP）的ROM值均值无显著差异。应用CF皮瓣患者的近端指间关节（PIP）和掌指关节（MCP）的平均ROM值显著低于HeNI皮瓣。
就改善手指关节的ROM而言，使用HeNI皮瓣进行指尖重建是一种可靠的一期选择。
