Repair of Multiple Finger Defects Using the Dorsal Homodigital Island Flaps

Multiple finger defects are common in hand trauma and result in functional disability. These injuries are often complex and severe, and thus reconstructive alternatives are limited. In this study, we use the dorsal homodigital island flaps, based on the dorsal branch of the digital artery, for reconstruction of multiple finger defects. At the final follow-up, we would evaluate the efficacy of this technique.

At final follow-up, sensation of the flap and the donor site would be assessed using static two-point discrimination and Semmes-Weinstein monofilament testing. The range of motion of the proximal interphalangeal joint and the distal interphalangeal joint of the injured finger is measured by a goniometer. The cold intolerance of the injured finger is measured using the self-administered Cold Intolerance Severity Score questionnaire that is rated into mild, moderate, severe, and extreme. The pain of the injured finger and the donor site is given subjectively by the patient using the visual analogue scale, which ranges from 0 to 10 cm and groupes into mild (0-3 cm), moderate (4-6 cm) and severe (7-10 cm).

Surgical flap is based on the dorsal branch of the digital artery, and is used for soft tissue coverageof multiple finger defects.

The test points are at the center of the flap.Each area is tested 3 times with a Discriminator. We stopp at 4 mm as a limit of two-point discrimination and consider this normal.

The cold intolerance of the injured finger was measured using the self-administered Cold Intolerance Severity Score questionnaire that was rated into mild, moderate, severe, and extreme.

Inclusion Criteria: a patient who had separate soft tissue defects in different fingers in same hand; the defect ≥ 1.5 cm and ≤ 3.5 cm in length; local tissue near the defect is uninjured; and a patient between 15 and 60 years of age. Exclusion Criteria: concomitant injuries to local tissue around the defect that precluded its use as donor site; a defect < 1.5 cm and ≥ 3.5 cm in length; a finger degloving injury; the defect of the thumb.

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