title: A Systematic Review of Outcomes and Complications of Primary Fingertip Reconstruction Using Reverse-Flow Homodigital Island Flaps.
abstract: BACKGROUND
  Fingertip reconstruction using reverse-flow homodigital island flaps has been very popular over the years. However, the outcomes of reconstruction have not been clearly understood. In these circumstances, a systematic review of available literature is warranted.
  
  
  OBJECTIVE
  To assess the outcomes and complications of fingertip reconstruction using reverse-flow homodigital island flaps. To justify the usage of reverse-flow homodigital island flaps for fingertip reconstruction.
  
  
  METHODS
  A PubMed [MEDLINE] electronic database was searched (1985 to 15 April 2015).
  Retrospective case series that met the following criteria were included: (1) Study reported primary data; (2) Study included at least five cases of fingertip defects treated using reverse-flow homodigital island flaps; (3) Study reported outcomes and complications of fingertip reconstruction, either primary or delayed, using reverse-flow homodigital island flaps; (4) The study presented at least one of the following functional outcomes: Static two-point discrimination, return-to-work time, range of motion of distal interphalangeal joints; (5) The study presented at least one complication.
  
  
  METHODS
  Two review authors independently assessed search results, and two other review authors analyzed the data and resolved disagreements. The following endpoints were analyzed: survival rate of the flap, sensibility, and functional outcomes and complications.
  
  
  RESULTS
  Eight studies were included in this review. The included studies were published between 1995 and 2014, and a total of 207 patients with 230 fingertip defects were reported. The overall survival rate of the flap was 98 % (including partial survival). The mean static two-point discrimination (2PD) was 7.2 mm. The average range of motion of the DIP joint was 63°. The average return-to-work time was 7 weeks after injury. On average, 2 % of the patient had complete flap necrosis, 5 % had partial flap necrosis, 4 % developed venous congestion, 4 % developed flexion contracture, and 12 % experienced mild-to-moderate cold intolerance.
  
  
  CONCLUSIONS
  Survival of reconstructed fingertips (98 %) is better with reverse-flow homodigital island flaps than fingertip replantation (86 %). The sensibility outcome using sensate flaps (mean s2PD = 7.2 mm) is similar to the sensibility outcome following replantation (mean s2PD = 7 mm). The common complications include cold intolerance, venous congestion, and flexion contracture. Therefore, reverse-flow homodigital island flaps may not be the ideal choice but are a very reliable alternative for fingertip reconstruction.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, No. 98 Nantong West Road, Yangzhou City, 225001, Jiangsu Province, People's Republic of China.
authors.forename: Subhash
authors.initials: S
authors.lastname: Regmi
authors.affiliation: Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, No. 98 Nantong West Road, Yangzhou City, 225001, Jiangsu Province, People's Republic of China. gujiaxiang69@gmail.com.
authors.forename: Jia-xiang
authors.initials: JX
authors.lastname: Gu
authors.affiliation: Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, No. 98 Nantong West Road, Yangzhou City, 225001, Jiangsu Province, People's Republic of China.
authors.forename: Nai-chen
authors.initials: NC
authors.lastname: Zhang
authors.affiliation: Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, No. 98 Nantong West Road, Yangzhou City, 225001, Jiangsu Province, People's Republic of China.
authors.forename: Hong-jun
authors.initials: HJ
authors.lastname: Liu
mesh_terms: D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome
keywords: Fingertip amputation; Fingertip injury; Reconstruction; Surgical flaps; Surgical outcomes; Systematic review