Dorsoulnar flap for non-replantable Allen type 3 and 4 thumb amputations- retrospective analysis of 15 cases

Abstract

Purpose

The study aimed to evaluate the functional outcome of distal thumb amputations (Allen's type 3, 4) that were not replantable when treated with a dorsoulnar flap.

Methods

A retrospective review was conducted in 15 patients who underwent dorsoulnar flap for Allen's type 3 and 4 thumb amputations in a single hand surgery center. The patient demographics, level of injury, complications, and functional outcomes were analyzed. Functional outcome was assessed using the Fingertip Injuries Outcome Score (FIOS).

Results

The mean age was 26 years (range 19–35 years). The most common mechanism of injury was motorcycle spokes wheel injury (n = 9), followed by road traffic injury, door crush, and fall. The FIOS was good in 13 patients and fair in 2 patients. The complications included hairy skin (n = 3), absent nails (n = 4), and cold intolerance (n = 2).

Conclusions

Our study suggests that the dorsoulnar flap is a simple and reliable reconstructive option for severe crush injuries resulting in Allen type 3 and 4 thumb amputations, with the potential to achieve good functional outcomes.

Keywords

Dorsoulnar flap Allen type 3 and 4 thumb amputations FIOS thumb reconstruction good outcome

Get full access to this article

View all access options for this article.

References

Henry

Wei

. Thumb reconstruction with toe transfer. J Hand Microsurg 2010 Dec; 2: 72–78.

Jerome

JTJ

Malshikare

. Graft reposition flap for fingertip injuries. Orthoplastic Surgery 2022; 8: 17–25.

Jerome

JTJ

. Reconstruction of motorcycle spokes wheel injury fingertip amputations with reposition flap technique: a report of 40 cases. Eur J Trauma Emerg Surg 2022 Feb; 48: 573–584.

Chung

Yoon

Malay

, et al. Patient-Reported and functional outcomes after revision amputation and replantation of digit amputations: the FRANCHISE multicenter international retrospective cohort study. JAMA Surg 2019; 154: 637–646.

Germann

Rudolf

Levin

, et al. Fingertip and thumb tip wounds: changing algorithms for sensation, aesthetics, and function. The Journal of Hand Surgery 2017; 42: 274–284.

Tang

Elliot

Adani

, et al. Repair and reconstruction of thumb and fingertip injuries: a global view. Clin Plast Surg 2014 Jul; 41: 325–359.

Terán

Carnero

Miranda

, et al. Refinements in dorsoulnar flap of the thumb: 15 cases. The Journal of Hand Surgery 2010; 35: 1356–1359.

Jose Jerome

Malshikare

. Fingertip injuries outcome score. Plastic and Reconstructive Surgery Global Open 2022; 10

Lim

Chung

. VY Advancement, Thenar Flap, and Cross-finger Flaps. Hand Clin 2020 Feb; 36(1): 19–32. doi: https://doi.org/10.1016/j.hcl.2019.08.003. PMID: 31757344

10.

Couceiro

Menendez

Manteiga

. The first dorsal metacarpal artery flap family: a review. The Surgery Journal 2018; 4: e215.

11.

Brunelli

. Le lambeau dorso-cubital du pouce [Dorso-ulnar thumb flap]. Ann Chir Main Memb Super 1993; 12: 105–114.

12.

Pagliei

Rocchi

Tulli

. The dorsal flap of the first web. J Hand Surg Br 2003 Apr; 28: 121–124.

13.

Moschella

Cordova

Pirrello

, et al. Anatomic basis for the dorsal radial flap of the thumb: clinical applications. Surg Radiol Anat 1996; 18: 179–181.

14.

Jerome

Malshikare

. An evidence-based approach to the fingertip diseases: fingertip injuries outcome score. 1st ed. Delhi, India: Thieme Medical Publishers, 2023, pp. 223–228.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB