title: Combined usage of hydroxyapatite and cross-finger flap for fingertip reconstruction.
abstract: Reconstruction for fingertip defects categorized as Type 3 and Type 4 in Allen's classification is challenging, because surgeons need to reconstruct not only the pulp but also great parts of the distal phalangeal bone. This paper introduces an original technique for the reconstruction of defects of these types. The defects of seven fingers (two small fingers and five index fingers) of seven patients (three males and four females; aged 14-44 years) were repaired. After the fingertip is divided in a fish-mouth fashion to expose the stump of the distal phalangeal bone, a curved block of hydroxyapatite is grafted to fill the phalangeal defect and straighten the nail bed. A rectangular flap is raised from the dorsal side of the neighbouring finger in the region between the PIP and DIP joints. Then the fish-mouth region carrying the grafted hydroxyapatite is covered with the rectangular flap to reconstruct the pulp. The rectangular cross-finger flap is separated 3-4 weeks postoperatively. In all seven cases, the flap survived completely. Infection developed in no case. In all cases, aesthetic appearance of the pulp and nail presented improvement, satisfying the patients. Combined usage of hydroxyapatite and a cross-finger flap from the neighbouring finger is an effective method for the reconstruction of type 3 and type 4 defects in Allen's classification.
authors.affiliation: Department of Plastic Surgery, Keio University , Tokyo , Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nagasao
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Kurihara
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Masahiro
authors.initials: M
authors.lastname: Toriumi
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Hua
authors.initials: H
authors.lastname: Jiang
authors.forename: Dazhi
authors.initials: D
authors.lastname: Yu
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kishi
mesh_terms: D000293:Adolescent; D000328:Adult; D018786:Bone Substitutes; D017886:Durapatite; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000601:surgery; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps; D055815:Young Adult
chemical_list: D018786:Bone Substitutes; D017886:Durapatite
keywords: amputation; finger; repair