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Background: Digital artery perforator flaps provide a useful option for reconstruction of soft tissue defects of the digits, and many variations of these flaps have been described for fingertip defects. This review aims to summarize various pedicled digital artery perforator flap anatomical configurations described in literature for fingertip reconstruction and their results. Methods: A literature review of PubMed, Medline and Embase databases was conducted. Studies reporting homodigital digital artery perforator flaps for fingertip reconstruction without sacrificing the proper digital artery were included in the review. Data collected included flap design, perforator location, pathology, defect location, flap dimensions, flap survival, sensory recovery, range of movement, outcome measures, and complications. The flaps were analysed and categorized based on flap location, flap design, transfer method, and flap innervation. Results: Pedicled digital artery perforators have been described in various configurations by different authors including propeller, bilobed, V-Y advancement, rotation and turnover flaps. Variations to make these flaps sensate have also been described. According to the available reports, these flaps have low complications and high patient satisfaction rates. Conclusion: Pedicled digital artery perforator flaps provide a versatile option for the reconstruction of fingertip and thumb tip defects. Various flap options are available for use depending on the reconstructive need. They are quicker and easier to perform than free flaps and can provide excellent outcomes in suitable cases.
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BACKGROUND: Most studies on the superficial palmar branch of radial artery (SUPBRA) flap involve its use as a free flap with only few reports in literature regarding its use as a reverse pedicled flap. This systematic review presents a summary of the available literature on the indications, anatomy, technique, complications and outcomes of the reverse SUPBRA flap and also describes our experience. METHODS: A computer search was performed on the Embase, Medline and Pubmed databases for clinical studies describing the reverse SUPBRA flap in accordance with the standard principles for systematic review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A retrospective review of cases performed by the senior author was also conducted. RESULTS: Seven studies qualified for the review with 50 flaps in 50 patients meeting the inclusion criteria. The senior author has performed nine reverse SUPBRA flaps from 2006 to 2015. The flap was found to be most useful for defects of the thumb, index, palm and first webspace. Variations in vascular anatomy may necessitate a change of operative strategy. Venous congestion was common but transient in the majority. Complications were rare and included minor tip necrosis, scar contracture, donor site sensitivity and numbness, thumb adduction contracture and cold intolerance. CONCLUSIONS: The reverse SUPBRA flap is a versatile flap for reconstructing defects of the thumb, index, palm and first webspace. It is quick to raise, has a low donor site morbidity and complication rate and achieves very reasonable functional and aesthetic outcomes.
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Illustrations are routinely used in medicine for teaching, communication, record keeping, research and publication purposes. Many medical professionals including the author prefer to create their own medical illustrations for use in presentations and publications. With the advent of digital media, it has become easier to create good quality illustrations even for those with limited artistic skills including the author. This article describes the author's experience with creating medical illustrations using digital media and discusses the benefits of the new technology. A few useful tips are also provided for medical professionals who would be interested in exploring the option of creating their own illustrations using digital tools.
RESUMEN
Digital replantations are often complicated by problems of venous congestion. Conservative management is not always successful. Furthermore, the skin edge around the replanted digit is frequently inflamed and necrotic, leading to difficulties in restoring venous flow by direct venous anastomosis or interpositional vein grafts. We introduce a novel solution using the proximally based cross-finger flap. We used this flap in 10 patients who had venous congestion with inflamed, necrotic skin at their digital replant site. Their initial injuries were amputation injuries. The flap had an average length of 3.98 cm and width of 2.59 cm and was harvested from the dorsum of the adjacent, uninjured digit. There was only 1 failure, due to massive crush injury. Of the remaining 9 cases, 7 met or exceeded the sensory threshold (Semmes-Weinstein monofilament test). The 2-point discrimination test was less than 6 mm in 8 cases. Three patients complained of residual pain (based on the Michigan Hand Outcomes Questionnaire), and only 1 was unsatisfied with the appearance. The proximally based cross-finger flap is pedicled and requires only a single level of venous anastomosis distally, leading to a higher success rate. It offers a simple yet effective solution for venous congestion.
