The Dorsal Homodigital Island Flap Based on the Dorsal Branch of the Digital Artery: A Review of 171 Cases

Study Overview
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Brief Summary
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Soft tissue reconstruction in the finger continues to evolve. The dorsum of the finger is a reliable flap donor site in reconstructive hand surgery because of its similar quality to the original. The dorsal homodigital island flap can be used as a reliable alternative for reconstructing small to moderate defects of the fingers. In this retrospective study, the investigators would evaluate the efficacy of the technique for tissue reconstruction in different regions of the finger, with an emphasis on sensibility, pain and donor site morbidity.

Detailed Description
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At final follow-up, sensory restoration of the flap is measured using the static 2-point discrimination test and Semmes-Weinstein monofilament test. We evaluate pain sensations of the reconstructed fingers and donor sites with a visual analog scale. The system consist of a 10 cm line that is grouped into mild (0-3 cm), moderate (4-6 cm) and severe (7-10 cm). Active motion of the joints is measured using a goniometer. The motion arcs of the reconstructed fingers are compared with the opposite side.

Conditions
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Soft Tissue Defect, Sensory Reconstruction of Digits, Multiple Digital Defects

Intervention / Treatment
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* Procedure: The dorsal homodigital island flap


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: the soft tissue defect in one finger or in multiple fingers a defect > 1.5 cm and < 3 cm in length necessity to preserve finger length a patient between 15 and 60 years of age Exclusion Criteria: injuries to the dorsum of the finger or to the course of the vascular pedicle that precluded its use as the donor a defect≤1.5 cm or ≥3 cm in length a soft tissue defect of the thumb

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 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: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Surgical flap<br>The dorsal homodigital island flap is a perforator type flap based on the DB, which uses the dorsal skin of the injured finger to provide soft tissue coverage for a volar defect. | Procedure: The dorsal homodigital island flap<br>* The dorsal homodigital island flap is used for tissue reconstruction in different regions of the finger.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Static 2-point discrimination test | The test point is at the center of the flap. Each area was tested 3 times with a Discriminator (Ali Med, Dedham, MA). We stop at 4mm as a limit of 2PD and considered this normal. | 18 months to 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cold intolerance | We access the cold intolerance of the injured and donor fingers using the self-administered Cold Intolerance Severity Score questionnaire10 that is rated into mild, moderate, severe, and extreme (0-25, 26-50, 51-75 and 76-100). | 18 months to 24 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Soft tissue defect, dorsal branch of the digital artery, dorsal branch of the digital nerve, dorsal homodigital island flap