Clinical effects of resurfacing fingertip amputations in long fingers using homodigital dorsal neurofascial broaden pedicle island flaps

Figures & data

Figure 1. Schematic illustration of the use of HDNBPIF in treating fingertip amputation. HDNBPIF is designed and superficial skin channel is cut like shown in (A). Black arrow shows the dissected digital nerve in flap. Green arrow shows the broaden pedicle. Grey arrow shows the stump of the proper digital nerve. We rotated the flap with the flap’s vascular nutrient stripe and the broaden pedicle is also shown in (B). Red arrow shows the pivot point. Green arrow shows the rotated broaden pedicle. Blue arrow shows the nutrient stripe of flap.

Figure 2. Typical case presentation. An Allen’s type 3 fingertip amputation is shown in (A). The exact location and width of flap and broaden pedicle is shown in (B). During operation, we dissected the digital nerve in the flap (C). Postoperative status was shown in (D). At 18 months follow-up, the index finger showed good contouring and appearance (E and F).

Table 1. Patients and results.

Patients	Age	Sex	Finger	Detect size (cm)	Flap size (cm)	Nutrient stripe length (cm)	Broden pedicle length (cm)	Allen’s type	Etiology	Duration of operation (min)	Final follow-up (months)
1	53	M	III	1.5 × 1.5	1.7 × 1.6	4.5	0.5	3	Crush	90	24
2	38	M	IV	1.0 × 1.0	1.1 × 1.2	4	0.3	2	Clean cut	140	25
3	32	F	II	1.5 × 1.2	1.8 × 1.4	4.3	0.5	3	Crush	165	21
4	34	M	IV	1.5 × 1.0	1.8 × 1.2	4.1	0.4	2	Clean cut	115	22
5	26	M	IV	1.0 × 1.0	1.1 × 1.2	4.2	0.4	2	Clean cut	105	18
6	49	F	III	1.0 × 1.2	1.2 × 1.0	4.6	0.5	2	Crush	110	16
7	30	M	V	0.8 × 1.0	1.0 × 1.2	3.5	0.3	2	Crush	90	16
8	50	F	II	1.0 × 1.2	1.1 × 1.4	4.2	0.5	2	Clean cut	85	18
9	50	M	III	0.8 × 1.3	1.0 × 1.6	4.5	0.5	2	Crush	105	17
10	42	M	II	1.0 × 1.0	1.2 × 1.3	4.3	0.5	3	Crush	145	16
11	51	M	II	0.8 × 1.0	1.0 × 1.2	4.1	0.5	2	Clean cut	115	12
12	25	M	II	0.6 × 1.0	0.8 × 1.2	4	0.5	2	Clean cut	80	12
13	53	M	III	0.8 × 1.1	1.0 × 1.3	4.6	0.5	2	Clean cut	105	13
14	44	M	III	1.4 × 1.3	1.7 × 1.6	4.4	0.5	3	Crush	145	14
15	70	M	III	1.5 × 0.8	1.8 × 0.9	4.5	0.5	3	Crush	185	13
15	70	M	IV	1.0 × 1.0	1.2 × 1.2	3.9	0.4	3	Crush	185	13
16	41	M	V	0.8 × 1.0	1.0 × 1.2	3.4	0.3	2	Clean cut	125	14
17	47	M	II	2.0 × 1.8	2.3 × 2.0	4.2	0.4	3	Crush	140	14

Table 2. Demographic and surgical details of the cases in this study.

Items	Mean (range)
Age (years)	47 (26–70)
Sex (M/F)	14/3
Side (L/R)	13/5
Recipient fingers (I/M/R/L）	6/6/4/2
Defect size (cm × cm)	1.11 × 1.13 (0.6 × 1.0 to 2.0 × 1.8)
Flap size (cm × cm)	1.32 × 1.32 (0.8 × 1.2 to 2.3 × 2.0)
Broden pedicle length (cm)	0.45 (0.3–0.5)
Nutrient stripe length (cm)	4.18 (3.4–4.6)
Operating time (min)	122.9 (80–185)
Etiology (Crush/Clean cut)	10/8
Follow-up time (months)	16.6 (12–25)

Table 3. Outcomes at the final follow-up.

Item		Mean (range)
		IS	CS
TAM	MCP	91.3	92.1
	PIP	99.5	101.0
	DIP	64.8	75.3
	Total	255.6	268.4
	Grade (excellent/good/fair/poor)	0/18/0/0	/
SWM test		IS	CS
	In flap	3.90	3.22
	At donor site	3.22	3.00
Static 2PD test		IS	CS
	In flap	5.61	3.72
	Grade (excellent/good/fair/poor)	9/9/0/0	18/0/0/0
	At donor site	4.33	3.56
	Grade (excellent/good/fair/poor)	17/1/0/0	18/0/0/0
VAS scores		IS	CS
		0.7 (0–4)	0.2 (0–2)
Quick DASH scores		5.81 (0–20.46)
Aesthetic Satisfaction	Grade (very poor/poor/sufficient/good/excellent)	0/0/3/8/6

Table 4. Vancouver scar scale results at the donor and recipient sites.

		Scale
Item	Range	0	1	2	3
On donor site, n (%)
Pigmentation	0–2	7 (38)	10 (56)	1 (6)	0
Height	0–1	6 (33)	12 (67)	0	0
Pliability	0–2	5 (27)	12 (67)	1 (6)	0
Vascularity	0–2	8 (44)	9 (50)	1 (6)	0
On donor site, n (%)
Pigmentation	0–2	10 (56)	7 (38)	1 (6)	0
Height	0–1	10 (56)	8 (44)	0	0
Pliability	0–2	8 (44)	9 (50)	1 (6)	0
Vascularity	0–1	12 (67)	6 (33)	0	0