A Systematic Review of Outcomes and Complications of Primary Fingertip Reconstruction Using Reverse-Flow Homodigital Island Flaps

作者：Regmi Subhash; Gu Jia xiang^*; Zhang Nai chen; Liu Hong jun

来源：Aesthetic Plastic Surgery, 2016, 40(2): 277-283.

DOI：10.1007/s00266-016-0624-y

• Surgical flaps
• Fingertip injury
• Fingertip amputation
• Reconstruction
• Surgical outcomes
• Systematic review

Fingertip reconstruction using reverse-flow homodigital island flaps has been very popular over the years. However, the outcomes of reconstruction have not been clearly understood. In these circumstances, a systematic review of available literature is warranted.
To assess the outcomes and complications of fingertip reconstruction using reverse-flow homodigital island flaps. To justify the usage of reverse-flow homodigital island flaps for fingertip reconstruction.
A PubMed [MEDLINE] electronic database was searched (1985 to 15 April 2015).
Retrospective case series that met the following criteria were included: (1) Study reported primary data; (2) Study included at least five cases of fingertip defects treated using reverse-flow homodigital island flaps; (3) Study reported outcomes and complications of fingertip reconstruction, either primary or delayed, using reverse-flow homodigital island flaps; (4) The study presented at least one of the following functional outcomes: Static two-point discrimination, return-to-work time, range of motion of distal interphalangeal joints; (5) The study presented at least one complication.
Two review authors independently assessed search results, and two other review authors analyzed the data and resolved disagreements. The following endpoints were analyzed: survival rate of the flap, sensibility, and functional outcomes and complications.
Eight studies were included in this review. The included studies were published between 1995 and 2014, and a total of 207 patients with 230 fingertip defects were reported. The overall survival rate of the flap was 98 % (including partial survival). The mean static two-point discrimination (2PD) was 7.2 mm. The average range of motion of the DIP joint was 63A degrees. The average return-to-work time was 7 weeks after injury. On average, 2 % of the patient had complete flap necrosis, 5 % had partial flap necrosis, 4 % developed venous congestion, 4 % developed flexion contracture, and 12 % experienced mild-to-moderate cold intolerance.
Survival of reconstructed fingertips (98 %) is better with reverse-flow homodigital island flaps than fingertip replantation (86 %). The sensibility outcome using sensate flaps (mean s2PD = 7.2 mm) is similar to the sensibility outcome following replantation (mean s2PD = 7 mm). The common complications include cold intolerance, venous congestion, and flexion contracture. Therefore, reverse-flow homodigital island flaps may not be the ideal choice but are a very reliable alternative for fingertip reconstruction.

• 出版日期2016-4
• 单位扬州大学