The Reverse Cross Finger Flap - ScienceDirect Contraindications: Extensive tissue defects crossing the finger joints. Indications and Contraindications. However, most DIMF cases have large areas of injured soft tissue, and abdominal skin covers a large area, but is much thicker . Thumb opposition requires the action of several muscles, those responsible for positioning the thumb and those providing compressive forces for pinch. sate flap (12). the thenhr flap when compared to the cross-finger or any other flap for treatment-of major distal phalangeal amputations. ③ In the digital artery island flap technique, a major artery is compromised. Secondary intention. Double Cross-Finger Flaps: A Novel Technique for ... 16. We review our experience with this flap and describe technical refinements that have contributed to improved early outcome and long-term neurosensory recovery. Cross-finger flaps are local flaps that can reliably provide padding and durable cover for fingertip injuries and have been in use for over 50 years (7,8).The anatomy, indications and contraindications, technique, and results of treatment of the cross-finger flap and the reverse (deepithelized) cross-finger flap for coverage of fingertip injuries will be described. Reconstruction of an eponychial skinfold and coverage of an exposed extensor tendon near the IP joint. Foucher flap is an eponymous flap based on the first dorsal metacarpal artery and was first described by the French Hand surgeon Guy Foucher. Fingertip reconstruction with flaps and nail bed grafts. Treatment of degloving injury involving multiple fingers ... The patient had full range of a The donor site is closed with a skin graft. The key procedural steps, special considerations, and technique . We present the new method of split-thickness skin with pedicle used on 12 patients (18 fingers) between 2012 and 2016. Clinical Application of Split-Thickness Skin with Pedicle ... Ganga Hand & Microsurgery Operative Course | Live Virtual ... Ulnar Nerve decompression & anterior transposition. ③ In the digital artery island flap technique, a major ar-tery is compromised. To examine the efficacy of combination of the reverse dorsoradial flap of the thumb and middle finger proper digital arterial island flap for repair of distal thumb degloving injury. Repair of finger soft tissue defects is the most common problem that hand surgeons address. PDF Upper Extremity Amputation Through various advancements and modifications, this technique helps deal with various types of finger injuries. VENTRAL TRUNK. We review our experience with this flap and describe technical refinements that have contributed to improved early outcome and long-term neurosensory recovery. The advantages are underlined of the use of the neurovascular flap, as seen in a patient with injuries in all anatom- A cross-finger flap is coded as 15574, and division is coded as 15620. Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger. Vol. [PDF] Review of Cross-Finger Flaps - Indications and ... - Cross finger flap - Thenar flap - Radial forearm flap - Posterior interosseous flap - Groin flap . Thirty patients underwent 31 cross finger flaps to the thumb . A combination of the reverse dorsoradial flap of the thumb and the middle finger proper digital . Surface Landmarks; Flap Elevation; Reverse Cross-Finger Flap; Innervated Cross-Finger Flap; References; PART III Clinical Applications: Trunk. - finger tip • V-Y advancement, cross finger flap, island flap (retrograde or antegrade flow), thenar flap (index or long finger only), bioengineered products (Matristem extracellular matrix). Three weeks later this flap was divided and the thumb was mobilized freely. Amongst all these, the FDMA flap is a versatile flap for covering distal thumb defects on dorsal or volar aspects (Kodi K Azari Wang et al 13 used a cross-finger flap and a composite-free flap from the dorsum of the second toe to treat 18 cases of distal degloving injuries, and Kim et al 3 used a thigh free flap to treat hand degloving injury. Methods. 59 Flap Options and Technical Considerations in the Trunk. The flap is commonly harvested from the adjacent finger due to its ease of positioning. The Cross-Finger flap. Thenar Flap. The Kutler method of repair of finger tip amputations. Conventional flap: incise at the dorsolateral border of the digit and raise the flap in the plane above the tendon, with preservation of the paratenon; free the laterovolar vessels as far as possible without violating the neurovascular bundle, then suture the flap into the defect; apply a skin graft to the donor site. Thenar Flap Guang Yang, MD Kevin C. Chung, MD, MS > Includes video Chapter 3 14 Cross-Finger Flap and Reverse Cross-Finger Flap Peter Charles Rhee, DO, MS > Includes video Chapter 4 23 V-Y Flaps for Finger Injuries Heather Baltzer, MD, MSc, FRCSC, FACS Chapter 5 30 Homodigital Island Flap Mark Henry, MD > Includes video Chapter 6 39 The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. Reverse . Concomitant injuries of the neighboring fingers. - finger tip • V-Y advancement, cross finger flap, island flap (retrograde or antegrade flow), thenar flap (index or long finger only), bioengineered products (Matristem extracellular matrix). The donor finger for CFF to thumb is classically the index finger (IF), the next most important finger of the hand.1,4 It is involved in the eight basic positions of the hand that make up most maneuvers.5 Cross-finger Flap to the Thumb: Quest for an . 21,22 When two-point discrimination results were compared between the innervated flap and the reverse island flap, the neurovascular island flap was superior at the initial stage, but there was no difference at the end of follow-up. Though there is the need for a split skin graft to cover the secondary defect produced by a transposition flap its design allows enough movement to . complete healing takes 3-5 weeks. Therefore, finding a new repair method for finger skin defects is an urgent problem to be . SURGICAL TECHNIQUE: Harvesting of an adipocutaneous flap from the dorsum of the finger to the midlateral line, preserving the paratenon of the donor phalanx. In addition, long-term follow-up of cross-finger flap technique reported very good sensory recovery. after 7-10 days, soaks in water-peroxide solution daily followed by application of soft dressing and fingertip protector. Posterior Trunk Flap Options; 60 . Extremity Flap Reconstruction. Surgical technique: Harvesting of an adipocutaneous flap from the dorsum of the finger to the midlateral line, preserving the paratenon of the donor phalanx. Anterior Trunk Flap Options; DORSAL TRUNK. For the reversed cross-finger flap preparation of a subcutaneous flap with preservation of the peritenon by separating a skin flap from the subcutaneous fat according to the "open book - closed book" technique. DEFECT WITH NEUROVASCULAR CROSS-FINGER FLAP AFTER ELECTRICAL BURNS Terziqi H., Krysander L. CUC, Surgery Clinic, Reconstructive and Plastic Surgery Department, Pristina, Kosova SUMMARY. Cross-Finger Flap. Brachial Plexus Exploration & Nerve Transfer. B, Eighteen months afte thenar repair donor r sit,e is inconspicuous and recipient finger Choice of the patient suitable for such technique is based upon fulfillment of certain criteria. Previous article. In our series, 22 cases of ring avulsion injuries were operated upon by this new technique. Therefore, finding a new repair ① The advancement distance of the V-Y advancement flap is generally no more than 1.0 cm. Key words: Cross-finger flap, Distally based cross-finger flap, Jumping cross-finger flap, Multiple cross-finger flaps, Proximally based cross-finger flap, Reverse dermis cross-finger flap Access this article online www.ijss-sn.com Month of Submission : 07-2017 One technique for replacing this area is a reversed deepithelialized dorsal cross finger flap, which is demonstrated with this case. Chao Chen, Peifu Tang, Lihai Zhang, Bin Wang, Treatment of Fingertip Degloving Injury Using the Bilaterally Innervated Sensory Cross-Finger Flap, Annals of Plastic Surgery, 10.1097/SAP.0b013e31828d7258, 73, 6, (645-651), (2014). The Hueston flap in reconstruction of fingertip skin loss: results in a series of 41 patients. The crossed digital flap is a reconstructive technique indicated for surgical defects of the fingers, as it is an interpolated flap carried from an adjacent finger used after a wide excision of melanoma on the plantar aspect of the fifth toe. Reconstruction using an advancement flap, cross-finger flap, and an innervated cross-finger pulp flap are very popular, and pedicled flap within hand matches the texture of the fingertips very closely, the loss of the main pedicle is a major drawback of this reconstruction technique. A, Oblique palmar distal phalangeal amputation wit ohf majo long fingerr pul losps an d exposed bone. Click on each image for a larger picture This 40 year old man on insulin for diabetes sustained loss of the dorsal soft tissues of his dominant index and middle fingers in a rotating blade injury. Background: Cross-finger flaps, over time, have become the one of the best reconstructive method in order to reconstruct fingers with significant soft tissue loss. We review our experience with this flap and describe technical refinements that have contributed to improved early outcome and long-term neurosensory recovery. It is claimed that this gives near normal restoration of sensation to the tactile surface of the thumb. Anatomy; Surgical Technique. ASSH Surgical Anatomy: Flap Reconstruction - Videos Video 2-1: Reconstruction of a fingertip amputation and pulp defect using a thenar flap Guang Yang, MD, Kevin C. Chung, MD, MS Video 3-1: Cross-finger flap technique Peter Charles Rhee, DO, MS Video 3-2: Reverse cross-finger flap technique Peter Charles Rhee, DO, MS 26 Volar soft tissue defects located on the middle or distal phalanx can be covered with this flap. Immobilization of both fingers until the pedicle is transected. Twelve patients with mechanical distal thumb degloving injuries were treated between February 2017 and August 2019. - good color and texture match for pulp; The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. Cross-Finger Flap. Replantation. ② A two-stage operation is required to implement the cross-finger or thenar flap. ① The advancement distance of the V-Y advancement flap is generally no more than 1.0cm. Another indication of the cross-finger flap is for more distal defects in which more tissue is required for coverage than . The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. A new technique is described using a cross-finger flap or flaps with transfer of the superficial terminal branch of the radial nerve. initial treatment with irrigation and soft dressing. Repair of Nerves at the wrist and hand. Background. Similarly, the reverse digital artery flap from the The reposition flap technique is simple to perform with a mean operating time of 51 min in our study. Despite somedisadvantages, cross-finger pulp flap is a relatively simple procedure without significantcomplications or requiring special techniques.Methods This study included 90 patients with fingertip defects who underwent cross-fingerpulp flap between September 1998 and March 2010. Proper flap coverage is important for preserving finger length and appearance [].Surgical techniques are required to meet aesthetic and functional needs and provide maximum protection of the donor site, with a low complication rate [2, 3].When restoring the appearance and function of the fingers, hand . 2. The thenar flap - an analysis of its use in 150 cases. Choice of the patient suitable for such technique is based upon fulfillment of certain criteria. Cross finger flap technique• The flap is elevated from the adjacent finger dorsum in the plane above the peritenon to allow for grafting of the donor site.• A full-thickness graft can be taken to close the donor finger dorsum.• The flap is opened like a book cover, turned 180°, and inset into the fingertip defect. Reversed cross-finger flap: soft-tissue defects in the dorsal proximal or middle phalanges not suitable for skin transplantation. - thumb • <2cm: Moberg Advancement Flap • >2cm: Neurovascular island Flap (Littler) or FDMA • Full pulp loss: toe transfer/wrap around flap [The cross-finger flap]. Full thickness skin grafting from hypothenar region. 2. Skin grafts cannot be used when bone or tendon is exposed. The fingers may be treated in the same way for similar injuries. We review our experience with this flap and describe technical refinements that have contributed to improved early outcome and long-term neurosensory recovery. Donor site problems an joindt contractures were infrequen seriet in this osf 150 thenar flaps. Despite somedisadvantages, cross-finger pulp flap is a relatively simple procedure without significantcomplications or requiring special techniques.Methods This study included 90 patients with fingertip defects who underwent cross-fingerpulp flap between September 1998 and March 2010. Download pdf. The fingers may be treated in the same way for similar injuries. The homodigital island flap is a wellestablished technique for fingertip reconstruction. A Darrach procedure (Removing the head of the distal ulna) is an effective procedure for treatment of distal radio-ulnar joint problems such as arthritis and other conditions causing ulnar sided wrist pain with ulnar impingement type symptoms. See also: cross flap . Cross-finger (described by Gurdin and Pangman in 1950) and thenar flap Used for volar oblique, substantial pulp tissue loss, and multiple fingertip injuries Disadvantage is use of two stage procedure and stiffness from prolonged immobilization Contraindicated in pts with RA, DM, and vasospastic disorders These cross-finger, thenar and distant flap procedures require appropriate patient compliance and may be somewhat cumbersome. Traditionally, the flap is elevated in the plane lying superficial to the extensor tendon. The thumb defects with bone exposure often require other alternative closure techniques as: Cross-finger flap, Littler flap or Kite flap. A new approach "Double Cross-Finger Flaps" was used for coverage of ring avulsion injuries. In our series, 22 cases of ring avulsion injuries were operated upon by this new technique. It also requires more hand surgical training and expertise than those pro-cedures that could be provided by a physician trained in.emergency medicine. However, the skin graft requirement and a need of secondary operation in patients undergoing cross-finger flap together should be mentioned as the main disadvantages of this technique. Microsurgery. Island Flaps of the Hand. By Semih Takka. When repairing a fingertip defect with a cross-finger flap, both flap and graft CPT codes may be used. TECHNIQUE A well executed cross-finger flap does requir~ a more formal operative setting than the emer-gency department. Skin grafts and pedicled flaps are the traditional methods of reconstructing injuries; both have some disadvantages. Fingertip reconstruction. A new approach "Double Cross-Finger Flaps" was used for coverage of ring avulsion injuries. - Cross finger flap / adipofascial flap - Venkatswami flap - Quaba flap - Foucher Flap - Littler flap - Moberg flap - Radial forearm flap + adipofascial flap - Baker flap Day Two Focusing on hand fracture management & operative techniques: Wide awake hand surgery; Approaches for fracture fixation advancement flap,[3] Moberg advancement flap,[1,4] cross-finger flap,[2,5] Littler's neurovascular island flap,[1,6] first . Free Flap to upper limb. Opponensplasty EIP. [4] Among these flaps, FDMA flap is a reliable flap for . See also: technique It is claimed that this gives near normal restoration of sensation to the tactile surface of the thumb. . What is cross finger flap? The coverage of defects was performed by using a flap (n = 23), cross-finger flap (n = 5), V-Y advancement flap (n = 28), reverse-flow homodigital island flap (n = 11), and full-thickness skin . Transfer of the flap into the defect of the neighboring finger and coverage of the donor site by full-thickness skin grafting. The flap is opened like a book cover, turned 180°, and inset into the fingertip defect. The cross-finger flap is a random pattern flap. Primary clo- sure, split-thickness skin grafting, orjust simple . partial toe transfer, ADP free flap, free groin flap can be used but such a technique requires microsurgical experience and prolonged operative time. The conventional cross finger flap is an established technique and is well suited for intermediate-sized partial pulp losses. Sucur et al. The innervated cross finger flap is a useful means of resurfacing fingertip defects with pulp soft tissue loss and has the added advantage of good sensibility and functional outcome. Related Papers. Nerve grafting Techniques. Darrach ECU FCU Tenodesis. The skin in this finger was indurated and tight secondary to the recent trauma and wound breakdown, leaving no slack for the use of a rotation flap, which allows direct closure of the donor site. • Indicated to reduce the space left between the index and ring finger following middle ray amputation. Patients and methods: This study comprised of 21 patients with finger injuries with exposed vital structures . 3 May 1982 The thenar flap 293 Fig. In our study, we demonstrated the effectiveness of reposition cross finger flap technique in motorcycle spokes wheel injuries with good pulp contour. crossed finger technique: A hazardous method of opening an unconscious patient's mouth by placing the thumb and index finger of a gloved hand on opposite rows of teeth and spreading the jaw open. To preserve finger length and function, flap transplantation rather than skin graft is usually performed to reconstruct the defective soft tissue. Transection of the flap pedicle after 14-21 days. Both have specific indications and limitations but with proven outcomes. The cross-finger flap is a two-staged flap reconstruction that was first described by Cronin 1951. Currently, there are several kinds of flaps available for covering defects of the fingers, like V-Y advancement flaps, rotation flaps, and cross-finger flaps [3, 4]. This damages the delicate subcutaneous tissues, which are important for the lengthening capacity of the skin of the dorsum of the fingers during flexion and extension. Wound Coverage Techniques for the Injured Extremity Gil Ortega, MD, MPH . fascial cross finger flap from the adjacent index finger was used to cover the dorsal surface and the tip of the thumb. 10.1055/b-0040-177489 74 Cross Finger (and Reverse) FlapJustin M. Miller, John M. Yingling, and John T. Capo Abstract The cross-finger flap and reversed cross-finger flaps are utilitarian techniques for obtaining soft tissue coverage of phalangeal defects. However, each of these . Surgical technique: Harvesting of an adipocutaneous flap from the dorsum of the finger to the . - Flap • Review Non-surgical and Surgical Options for Soft-Tissue injuries . The radial artery enters the palm between the two heads of the first dorsal interosseus muscle. Here, we introduce a new clinical application of split-thickness skin with pedicle for repairing finger wounds. The reverse adipofascial cross finger flap was covered with split thickness skin graft. Access Options. 1.6 Reverse (dorsal) cross finger flap Indicated for soft-tissue defects in the dorsal proximal or middle phalanges not suitable for skin grafting.9 Figure 2: Reverse cross finger flap (schematic representation) Surgical technique - similar to classic cross finger flap procedure, a properly located, sized, and designed flap is Cross finger flap technique The flap is elevated from the adjacent finger dorsum in the plane above the peritenon to allow for grafting of the donor site. - thumb • <2cm: Moberg Advancement Flap • >2cm: Neurovascular island Flap (Littler) or FDMA • Full pulp loss: toe transfer/wrap around flap in issue. women) - Advantages: - more subcutaneous fat available than cross finger flap. 7, No. reported a similar technique for thumb tip reconstruction using the superficial terminal branch of radial nerve with near-normal sensibility [3]. Transection of the flap pedicle after 14-21 days. It is a complex movement requiring trapezio-metacarpal joint abduction, flexion and pronation. flaps, FDMA flap, cross-finger flaps and neurovascular island or radial sensory-innervated cross-finger flaps (Kodi K Azari and Andrew Lee, 2011). different uses of the flap and the modifications made in the technique. PLEASE VISIT WWW.UWHAND.COM FOR MORE INFORMATION ON THE UW HAND CENTER.A reverse cross finger flap is indicated in adults with defects on the dorsum of the f. Two cross-finger flaps were harvested, one to cover the . Transfer of the flap into the defect of the neighboring finger and coverage of the donor site by full-thickness skin grafting. Neurovascular island flaps using tissue from adjacent fingers can also be useful in providing sensate coverage (13,14). The cross-finger flap has been used successfully for decades. INTRODUCTION In a second stage 2-3 weeks later, the pedicle is divided and the fingers separated. advancement flap for the pulp reconstruction which was later modified for covering the skin defects of palmar tip of the thumb (3). Expand A full-thickness graft can be taken to close the donor finger dorsum. The reverse cross finger flap is technically more difficult than the regular cross finger flap. ever, these techniques have obvious limitations. - Discussion: - can be used for coverage of finger tip injuries the index, long, ring, (and in some cases the little finger); - can be used in children and young adults (esp. AB - Reconstruction for fingertip defects categorized as Type 3 and Type 4 in Allen's classification is challenging, because surgeons need to reconstruct not . A new technique is described using a cross-finger flap or flaps with transfer of the superficial terminal branch of the radial nerve. For the reversed cross-finger flap preparation of a subcutaneous flap with preservation of the peritenon by separating a skin flap from the subcutaneous fat according to the "open book - closed book" technique. The reverse cross finger flap is indicated in these situations: 1. cross-finger flap: a flap designed on the volar or (more commonly) dorsal surface of one finger and used to reconstruct the opposing surface of an adjacent finger or the thumb of the same hand. ② A two-stage operation is required to implement the cross-finger or thenar flap. technique. Opposition of the thumb is the most important component of normal hand function. Careful analysis shows that criticism of the thenar flap is due primarily to its being confused with the midpalmar flap, a procedure so prone to com-plications that it probably is never indicated. CONCLUSION The dorsal fascial flap can be applied as an alternative surgical method in patients with fingertip defects including nail loss or damage in order to . VY Advancement, Thenar Flap, and Cross-finger Flaps Jin Xi Lim, MBBSa,b,*, Kevin C. Chung, MD, MSc INTRODUCTION Fingertip amputations are one of the most com-mon problems presenting for acute care. • An alternative technique is deep transverse intermetacarpal ligament reconstruction. 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. The bone consolidation is 86% in group I and 88% in group II, . 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