title: Preventing postoperative congestion in reverse pedicle digital island flaps when reconstructing composite tissue defects in the fingertip: a patient series.
abstract: For reconstructing an injured fingertip, a reverse pedicle digital island flap can restore excellent function and appearance. However, postoperative flap congestion may lead to flap necrosis. We tested a method for dissecting the vascular pedicle to prevent congestion and to provide more reliable results. Between August 2002 and December 2010, we reconstructed 14 fingertips in 13 patients (average age, 43 years; range, 24 to 68 years; 9 men). Through a small zigzag incision, the digital artery and a 4-mm-wide subcutaneous venous network were elevated in retrograde fashion to facilitate venous drainage. All flaps healed completely without severe congestion or necrosis. Slight flexion contractures remained in the PIP (mean, 12°) and DIP (mean, 14°) joints. Our procedure is simpler and more reliable than other techniques, such as adding a narrow skin bridge to the pedicle or a venous anastomosis to prevent venous congestion, and it assures the survival of the flap.
authors.affiliation: Department of Orthopaedic Surgery, TsubameRosai Hospital, Tsubame 959-1228, Japan. hiro-mat@fa2.so-net.ne.jp
authors.forename: Hironori
authors.initials: H
authors.lastname: Matsuzaki
authors.forename: Hisao
authors.initials: H
authors.lastname: Kouda
authors.forename: Haruyoshi
authors.initials: H
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D005385:Fingers / Q000098:blood supply; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D055815:Young Adult