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

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Finger Injuries, Soft Tissue Injuries

Intervention / Treatment
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* Procedure: Dorsal digito-metacarpal flap


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Surgical flap<br>Dorsal digito-metacarpal flap is based on the dorsal digital artery and dorsal metacarpal artery. | Procedure: Dorsal digito-metacarpal flap<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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. | 18 to 24months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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. | 18 to 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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defect,, dorsal branch of the digital artery,, dorsal digital flap,, dorsal metacarpal artery flap.