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

Sponsor

The Second Hospital of Tangshan (Other)

Overall Status

Completed

CT.gov ID

NCT01927003

Collaborator

Chinese PLA General Hospital (Other)

Enrollment

Location

Arm

Duration (Months)

0.6

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

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.

Condition or Disease	Intervention/Treatment	Phase
Finger Injuries Soft Tissue Injuries	Procedure: Dorsal digito-metacarpal flap	N/A

Detailed Description

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 Design

Study Type:

Interventional

Actual Enrollment :

24 participants

Allocation:

N/A

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

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

Study Start Date :

Apr 1, 2009

Actual Primary Completion Date :

Sep 1, 2011

Actual Study Completion Date :

Sep 1, 2012

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Surgical flap Dorsal digito-metacarpal flap is based on the dorsal digital artery and dorsal metacarpal artery.	Procedure: Dorsal digito-metacarpal flap 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.

Arm

Intervention/Treatment

Experimental: Surgical flap

Dorsal digito-metacarpal flap is based on the dorsal digital artery and dorsal metacarpal artery.

Procedure: Dorsal digito-metacarpal flap

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.

Outcome Measures

Primary Outcome Measures

The Static 2-point discrimination test [18 to 24months]
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.

Secondary Outcome Measures

Patient satisfaction [18 to 24 months]
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.

Eligibility Criteria

Criteria

Ages Eligible for Study:

15 Years to 55 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

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