Search In this Thesis
   Search In this Thesis  
العنوان
Sensation Assessment of Dorsal Digital Artery Perforator Flap In Fingertip Reconstruction :
المؤلف
Mohammed, Mostafa Kotb Abdelrazik.
هيئة الاعداد
باحث / مصطفي قطب عبد الرازق
مشرف / محمد احمد خلف الله
مشرف / احمد جمال الدين عثمان
مشرف / احمد محمد جاد علي
تاريخ النشر
2019.
عدد الصفحات
114 P. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - الجراحة العامة
الفهرس
Only 14 pages are availabe for public view

from 114

from 114

Abstract

Fingertip amputation is really a complicated issue because high rate of incidence and highly specialized functions of it. Surgeons make their efforts to reconstruct fingertip normal shape and restore its function in the form of restoration of sensations, and it is a challenging procedure.
The fingertip is composed of; distal phalanx , the nail complex, Fibrous connective tissue network with the subcutaneous tissues, Vascular network, Nerves with end organs and the nonperionychial skin.
A fingertip injury is any soft tissue, nail or bony injury distal to the insertions of the long flexor and extensor tendons of a finger or thumb. Evaluation of injury should begin by taking history, then examination.
Many options found for the treatment of fingertip amputations. These include primary repair, revision amputation, non-vascularized and vascularized composite grafting, skin grafting, healing by secondary intention. When considering more complex wounds, we should consider local or regional flap coverage. These flaps can be classified as traditional local advancement flaps, staged flaps, and island flaps. However, most flaps are associated with drawbacks, such as the need to immobilize the finger, sacrifice digital artery, poor sensory return, limited advancement distance, or be multiple stages.
The digital artery perforator flap is a vascular island flap based on dorsal perforators of the digital artery at the level of the middle and distal thirds of the proximal phalanx, the middle third of the middle phalanx, and the distal interphalangeal joint. The entire dorsum of the middle and proximal phalanges can be used as the donor; this important feature makes it more versatile for reconstructing defects in different regions of the finger, especially for simultaneously reconstructing small to moderate defects in multiple fingers.
The flap is rotated around the perforators in a propeller-like fashion and can be easily applied and rotated to all types of fingertip defects, favours coverage of the dorsal oblique defects is easier.
This flap has advantages over multistage regional flaps being a single-stage procedure, simultaneous coverage of multiple-finger defects, sensory reconstruction in important anatomical regions, minimal donor-site morbidity, lower cost, and minimal disability time. Furthermore, the color and tissue coverage characteristics of the flap are excellent. DDAP flaps allow reconstruction of pulp defects without sacrificing the digital artery. The time period needed for recovery and return to work is relatively short when compared to the other methods.
Assessing both slowly and quickly adapting fibres in the fingertips is essential for establishing a baseline for sensation and developing a logical, sequential treatment plan for sensory re-education.
In this study we repaired fingertip amputations by DDAP flap without nerve coaptation and after a period of recovery, regaining of flap sensation was evaluated. We found that this flap has considerable sensory return fair enough that enable patient to manipulate and deal normally with life activities and protect his hand and fingers.
Homodigital donor-site morbidity is a major concern when raising a DDAP flap. Skin graft contracture and extensor tendon adhesion are inevitable, but early rehabilitation with the help of a physical therapist can be less prone to these complications.
In conclusion, the use of the DDAP flap for fingertip reconstruction appears to result in excellent functional and aesthetic outcomes without sacrificing the digital artery. Therefore, we suggest that the DDAP flap may be a useful technique in all types of fingertip pulp defects.