Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle
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HANDSURGERY
Comparison of reverse dorsoradial flap for thumb reconstruction: narrow pedicle versus wide pedicle Hongjiu Qin1 · Tao Ma1 · Jiang Xia2 · Wenxian Zhang3 Received: 16 February 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The reverse homodigital dorsoradial flap remains a useful alternative for covering thumb defects. However, the description of pedicle width of dorsoradial flap is not clear. The aim of this study was to compare the results of narrow pedicle with wide pedicle in dorsoradial flaps and describe our experience with the thumb reconstruction. Materials and methods From July 2014 to February 2019, 42 patients were treated with the reverse dorsoradial flap for thumb reconstruction. The patients were divided as Group A (pedicle width ≤ 0.8 cm) and Group B (pedicle width > 0.8 cm). Flap survival, time to return to work, flap sensibility, the range of motion (ROM) of the joints, and final aesthetic outcomes were evaluated. Results Respectively in the Group A (17 cases) and Group B (25 cases), 14–19 flaps survived uneventfully, whereas 3–6 flaps experienced venous congestion with no or partial flap loss. No significant difference was identified between the two groups for the incidence of venous congestion, static 2-point discrimination and ROM of the injured thumbs. Time to return to work was significantly shorter in Group A. The aesthetic satisfaction of the patients in Group A was significantly better comparing with that in Group B. Conclusions The reverse homodigital dorsoradial flap with narrow pedicle width is associated with more favorable outcomes in terms of time lost from work and aesthetic satisfaction of the patients. Keywords Thumb · Reverse flap · Venous congestion · Pedicle · Width
Introduction Soft tissue defects of the thumb with exposed bone or tendon are frequent injuries in trauma units. Various reconstructive options, including reversed-flow homodigital pedicled flaps, kite flaps, and free flaps, have been described to cover this area [1–8]. Because several surgical options exist, each with its own series of disadvantages and advantages, there is no perfect flap to handle all situations yet. Reconstruction of thumb defects is still a common but challenging problem.
* Wenxian Zhang [email protected] 1
Department of Hand and Foot Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
2
Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, China
3
Department of Orthopedics, Gansu Provincial Hospital of TCM, Lanzhou 730000, Gansu, China
The usefulness of the reverse homodigital dorsoradial flap for reconstruction of defects of the thumb was first described by Moschella in 1996 [4]. Advantages of this flap are the simplicity of surgical operations, low donor-site morbidity, and its independence from other digits [9]. Although many detailed surgical techniques have been reported previously, the description of vascular pedicle width remains vague. Some studies advocate th
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