Ulus Travma Acil Cerrahi Derg. 2024; 30(5): 337-342 | DOI: 10.14744/tjtes.2023.05118

Bone grafting combined with a spiral flap technique for the reconstruction of fingertip amputations

Fatih Ceran¹, Mehmet Bozkurt², Salih Onur Basat², Emin Kapi^3
1Department of Plastic, Reconstructive and Aesthetic Surgery, Biruni University Medical Faculty, Ýstanbul-Türkiye
²Department of Plastic, Reconstructive and Aesthetic Surgery, Ministry of Health Bagcilar Training & Research Hospital, Ýstanbul-Türkiye
³Department of Plastic, Reconstructive and Aesthetic Surgery, Ministry of Health Adana Numune Hospital, Adana-Türkiye

BACKGROUND: Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss.
METHODS: Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively.
RESULTS: Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5.
CONCLUSION: The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

Keywords: Amputation, bone graft, fingertip; reconstruction; spiral flap.

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Parmak ucu amputasyonlarýnýn rekonstrüksiyonunda kemik grefti ile kombine spiral flep tekniðinin kullanýmý

Fatih Ceran¹, Mehmet Bozkurt², Salih Onur Basat², Emin Kapi^3
1Biruni Üniversitesi Týp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Ana Bilim Dalý, Ýstanbul, Türkiye
²Saðlýk Bakanlýðý Baðcýlar Eðitim ve Araþtýrma Hastanesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Ana Bilim Dalý, Ýstanbul, Türkiye
³Saðlýk Bakanlýðý Adana Numune Hastanesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Ana Bilim Dalý, Adana, Türkiye

AMAÇ: Parmak distalinde ve pulpa defektlerinde greftleme, lokal veya uzak flep gibi farklý rekonstrüktif seçenekler mevcuttur. Normal anatomik yapýnýn yeniden yapýlandýrýlmasýnýn yaný sýra parmaðýn duyu fonksiyonunun korunmasý da önemlidir. Bu çalýþmada kemik kaybýnýn eþlik ettiði pulpa defektlerinin rekonstrüksiyonunda kemik greftleme ile kombine edilmiþ spiral flep tekniðinin (BGcSF) kullaným sonuçlarýný sunuyoruz.
GEREÇ VE YÖNTEM: Parmak ucu defekti olan 23 hasta BGcSF tekniði kullanýlarak tedavi edildi. Flep duyarlýlýðý ameliyat sonrasý 6. ayda Semmes-Weinstein monofilament (SW) ve statik 2PD testleri ile deðerlendirildi. Hasarlý parmaklarýn soðuk intoleransý, ameliyat sonrasý 1. yýlda Soðuk Ýntolerans Þiddet Skoru (CISS) anketi ile deðerlendirildi. Hasta memnuniyeti Michigan Hand Outcomes Questionnaire testi (MHQQ) kullanýlarak deðerlendirildi. Ameliyat sonrasý 1. yýlda hastalarýn proksimal ve distal interfalangeal eklem hareket serbestliði gonyometre ile ölçüldü. BULGULAR: Bir hastada %10-15 oranýnda flep boyutunda distal flep nekrozu gözlendi. Baþka bir komplikasyon görülmedi. Ameliyat sonrasý 6. ayda ortalama statik iki nokta ayrým deðeri 5.6 mm, ortalama SW skoru 3.56 olarak belirlendi. Ameliyat sonrasý 1. yýlda ortalama CISS deðeri 18.8 idi. Ortalama proksimal interfalangeal eklem aktif ROM açýsý 106.7 derece, distal interfalangeal eklem deðeri ise 65,4 olarak belirlendi. Ameliyat sonrasý 1. yýldaki ortalama MHQQ skoru 18.5 idi.
SONUÇ: BGcSF tekniði ile parmak ucuna benzer dokuya sahip yumuþak doku oluþturmak mümkündür. Bu teknik ile parmak ucunda duyu elde edilebilir. BGcSF, replantasyonun mümkün olmadýðý durumlarda parmak ucu rekonstrüksiyonu için iyi bir seçenek olarak düþünülebilir.

Anahtar Kelimeler: Amputasyon, kemik grefti, parmak ucu; rekonstrüksiyon; spiral flep.

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