Document Detail

Randomized prospective study comparing reverse and direct flow island flaps in digital pulp reconstruction of the fingers.
MedLine Citation:
PMID:  19952657     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: This study compares two therapies for the reconstruction of digital pulp: direct and reverse flow island flaps. Discriminatory sensation and loss of active range of motion were analyzed, with random allocation of nerve suturing.
METHODS: The authors conducted a randomized prospective study of 122 patients with loss of digital pulp substance in one finger between 1995 and 2005. Patients were divided into two groups: direct flow island flap (n = 62) and reverse flow island flap (n = 60). The main outcomes were the capacity to discriminate between two points, and proximal and distal interphalangeal joint motion loss.
RESULTS: In the direct flap group, there was no loss of articular mobility in 51 percent of patients in the proximal interphalangeal joint and in 55 percent of patients in the distal interphalangeal joint. The reverse flap group showed no loss of articular mobility of the proximal interphalangeal joint in 85 percent of patients and of distal interphalangeal joint in 82 percent. Maximum amplitude losses of 10 and 15 degrees were observed only in the direct flap group in proximal interphalangeal joint articulation (p < 0.001), and of 10 degrees in 10 percent of patients in distal interphalangeal joint articulation (p < 0.002). All patients (n = 29) with suturing showed a Weber score less than or equal to 8, whereas only four (13 percent) of those without suturing had a score of 8; the rest had higher Weber scores (p < 0.001).
CONCLUSION: The direct island flap resulted in motion loss in both articulations of the finger but with better discriminatory sensation in comparison with the reverse flap.
Jefferson Braga-Silva; Daniel Gehlen; Fabrício Bervian; Guilherme L da Cunha; Alexandre V Padoin
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  124     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-02     Completed Date:  2010-01-11     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2012-8     Citation Subset:  AIM; IM    
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MeSH Terms
Finger Injuries / diagnosis,  surgery*
Graft Rejection
Graft Survival
Hand Strength / physiology
Injury Severity Score
Prospective Studies
Reconstructive Surgical Procedures / adverse effects,  methods*
Recovery of Function
Risk Assessment
Sensation / physiology
Statistics, Nonparametric
Surgical Flaps / blood supply*,  innervation*
Young Adult
Comment In:
Plast Reconstr Surg. 2011 May;127(5):2129-31; author reply 2131-2   [PMID:  21532450 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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