Repair of Fingertip Degloving Injuries using the Extended Reverse Second Dorsal Metacarpal Artery Flap

Abstract

Background: This study aimed to introduce modified reverse second dorsal metacarpal artery flap (MRSDMAF) transfer for the treatment of fingertip degloving injuries. Methods: From January 2004 to March 2020, 31 patients with fingertip degloving injuries underwent MRSDMAF transfer. The mean defect and flap size were 4.5 cm×1.6 cm and 4.7 cm×1.7 cm, respectively. Nerve repair was performed in 18 fingers. Flap sensation, function restoration of the reconstructed fingers, and donor site morbidity were assessed. For comparison, we reviewed a cohort of 45 patients undergoing modified cross-finger flap (MCFF) transfer. Results: Complete flap survival was achieved in 28 fingers, and partial distal flap necrosis was noted in 3 fingers. After a mean of 24 months, the static 2PD was 8.6 ± 1.0 mm and 7.2 ± 0.8 mm in the MRSDMAF and MCFF with a significant difference (P＜.0001). Sensory restoration of the MRSDMAF group was inferior to that of the MCFF group. In addition, the MRSDMAF group presented a higher incidence of fingertip pain (P = .019) and suboptimal cosmetic appearance of the reconstructed finger (P = .036). On the donor site, the MRSDMAF group presented a lower incidence of scar pain (P = .030) and better appearance (P = .025). Conclusions: MRSDMAF transfer is an alternative treatment for fingertip degloving injuries, especially when MCFF transfer is not feasible. ClinicalTrials.gov ID: NCT01019811 CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic IIIa.