Long-term clinical outcomes of innervated digital artery perforator flap in the treatment of fingertip injuries

Özet

Objective: The aim of this study was to evaluate the long-term clinical outcomes of innervated digital artery perforator (IDAP)flap in the treatment of patients with fingertip injuries.Methods: Eighty-three patients (93 fingers; 70 male, 13 female; mean age = 35.2 years, age range = 5-65) with fingertip injurieswho underwent acute or late reconstruction with IDAP flap between 2011 and 2016 were retrospectively reviewed. The meanage was 35.2 (range = 5-65) years. Reconstructions performed in 85 fingers (91.4%) were acute, and 8 fingers (8.6%) were late.Hypersensitivity, cold intolerance, and patient satisfaction were questioned as subjective evaluation parameters. The objectivepatient outcome evaluations consisted of static two-point discrimination (s2PD) test, the Semmes-Weinstein monofilament(SWM) test, and range of motion of the reconstructed fingers.Results: The mean follow-up period was 33.1 (range = 12-62) months. The smallest flap size was 1.6 x 0.7 cm; the largest flap sizewas 4 x 2 cm. All flaps survived completely. There was no postoperative infection or donor site morbidity. Hyperesthesia wasobserved in 4 fingers (4.3%), of which 3 were mild and 1 was moderate. Eighteen patients (18 fingers, 19.3%) experienced mildcold intolerance on reconstructed fingertips. 75 patients (90.3%) were highly satisfied, and 8 patients (9.7%) were satisfied withfunctional and aesthetic results of their fingertip reconstructions. No range of motion limitation was observed in any joints of 90fingers (96.8%). The s2PD in the flaps ranged from 2 mm to 6 mm (mean = 3.71 ± 0.97 mm), compared with 2 mm to 5 mm (mean =2.73 ± 0.66 mm) on the contralateral hand. The SWM test results of the flaps ranged from 2.44 to 4.56, compared with 2.44 to 4.31on the contralateral hand. The difference regarding s2PD and SWM test was statistically significant (P < 0.001).Conclusion: IDAP flap seems to be a sensate, reliable, and versatile flap that can be used in acute and late reconstructions of anytype of fingertip defects. Satisfactory functional and aesthetic results can be achieved with better sensorial results and lowercomplication rates compared to other conventional reconstruction techniques.Level of Evidence: Level IV, Therapeutic Study