title: Direct and reversed dorsal digital island flaps: a review of 65 cases.
abstract: BACKGROUND
  Reconstruction of soft tissue defects in fingers continues to be a challenging problem. The purpose of this study is to report the reconstruction of small-to-moderate defects of fingers with dorsal digital island flap (DDIF) and to evaluate the efficacy of use of the flap.
  
  
  METHODS
  Over last six years, a retrospective study was conducted with 65 patients who had soft tissue defects of fingers treated with the DDIF. Sixty-nine soft-tissue defects were found in 69 fingers in 65 patients. Based on the flow direction of blood supply, the patients were divided into two groups: the direct (n=35) and reversed (n=30) DDIF groups. In addition, based on the different donor sites, the direct DDIF group was divided into two subgroups: the proximal phalangeal direct DDIF subgroup (n=16) and the extended pedicle direct DDIF subgroup (n=19). The main outcomes were static 2-point discrimination and Semmes-Weinstein monofilament scores of flap and joint motion.
  
  
  RESULTS
  At the final follow-up, the mean static two-point discrimination of the flaps was 9.7mm (range, 8 to 12mm) in the proximal phalangeal direct DDIF subgroup and 8.3mm (range, 7 to 11mm) in the extended pedicle direct DDIF subgroup, with a significant difference (p=0.005). In the direct DDIF group, there was no significant difference in total active motion between the donor fingers and the opposite sides. In the reversed DDIF group, the mean total active motion of the donor fingers was 170° and the data of the opposite sides was 181°, with a significant difference (p=0.024). Maximum amplitude losses of 15° were seen in 12% of patients in the distal interphalangeal joint.
  
  
  CONCLUSIONS
  The DDIF is reliable and technically easy for reconstructing small-to-moderate defects of fingers. The extended pedicle direct DDIF may be an optional solution when sensory reconstruction is needed.
authors.affiliation: The Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, PR China. Electronic address: ts_chenchao@163.com.
authors.forename: Chao
authors.initials: C
authors.lastname: Chen
authors.affiliation: The Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, PR China. Electronic address: tangpeifubeijing@163.com.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
authors.affiliation: Hand Surgery Department, The Second Hospital of Tangshan, Tangshan 063000, Hebei, PR China. Electronic address: ts_13717517534@126.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
mesh_terms: D005383:Finger Injuries / Q000503:physiopathology / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D014110:Touch; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Dorsal branch of the digital artery; Dorsal branch of the digital nerve; Dorsal digital island flap; Soft tissue defect