Direct and Reversed Dorsal Digito-metacarpal Flaps: A Review of 24 Cases

N/ACompletedNCT01927003

The Second Hospital of Tangshan24 enrolled

Overview

Multiple digital injuries are often complex and severe, and the commonly used local and regional flaps may not be feasible. The authors reconstruct soft tissue defects of the fingers using the dorsal digito-metacarpal flap and evaluate the efficacy of this technique.

At final follow-up, we measure the sensibility of the flaps using the static 2-point discrimination test. The Static 2-point discrimination test determines the minimal distance at which a subject can sense the presence of two needle. The modified American Society for Surgery of the Hand guidalines are used to stratify discriminator measurements(excellent \<6 mm, good 6-10 mm, fair 11-15 mm, poor \>15 mm). Each area is tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers are considered proof of perception before proceeding to another lower value. We stopp at 4mm as a limit of 2PD and consider this normal. The measurements are performed at a single time point at final follow up.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Finger Injuries Soft Tissue Injuries

Interventions

Dorsal digito-metacarpal flapPROCEDURE

The dorsal digito-metacarpal flap is a vascular island flap based on the dorsal digital artery and dorsal metacarpal artery. It has a longer vascular pedicle and provides tissue coverage of similar quality as that of normal glabrous skin but not sacrifice the digital artery.

Eligibility

Sex: ALLMin age: 15 YearsMax age: 55 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * the injured and adjacent fingers are unable to be used as the donor due to multiple digital injuries * a soft tissue defect \> 1.5 cm in length with exposed bone or tendon * the reverse DMA flap may not be appropriate for tissue reconstruction due to the concomitant injuries or due to the limitation of the rotation arc * a patient between 15 and 60 years of age Exclusion Criteria: * concomitant injuries involved all the finger that precluded their use as donor sites * a defect less than 1.5 cm in length * injuries to the course of the vascular pedicle

Locations (1)

The Second Hospital of Tangshan

Tangshan, Hebei, China

Outcomes

Primary Outcomes

The Static 2-point discrimination test

The Static 2-point discrimination test determines the minimal distance at which a subject can sense the presence of two needle. The modified American Society for Surgery of the Hand guidalines are used to stratify discriminator measurements(excellent \<6 mm, good 6-10 mm, fair 11-15 mm, poor \>15 mm). Each area is tested 3 times with a Discriminator (Ali Med, Dedham, MA). Two out of 3 correct answers are considered proof of perception before proceeding to another lower value. We stopped at 4mm as a limit of 2PD and considered this normal. The measurements are performed at a single time point at final follow up.

Time frame: 18 to 24months

Secondary Outcomes

Patient satisfaction

Patients report their satisfaction with the appearance of the flap and the donor site according to the Michigan Hand Outcomes Questionnaire that is based on a 5-point response scale.

Time frame: 18 to 24 months

Data from ClinicalTrials.gov

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