Original article / research
Comparison of Bilateral V-Y Rotation Advancement Flap, Homodigital Island Flap and Cross Finger Flap for Reconstruction of Fingertip Amputations: A Prospective Interventional Study
PC05-PC10
Correspondence
Dr. Harish Kumar Sharma,
Professor, Department of Burns, Plastic and Maxillofacial Surgery, VMMC and Safdarjung Hospital, New Delhi-110029, India.
E-mail: drharishpls@gmail.com
Introduction: The aim of reconstruction for fingertip amputations is to provide stable soft-tissue coverage while preserving length, preventing joint stiffness, minimising neuromas, restoring normal sensation and achieving an acceptable cosmetic outcome. Cross-Finger (CRF) flaps and Homodigital Island (HDI) flaps have been workhorse flaps for fingertip amputation reconstruction for decades.
Aim: To assess the long-term functional and aesthetic outcomes of the Bilateral V-Y Rotation Advancement (BV-YRA) flap compared to CRF and HDI flaps.
Materials and Methods: This was a prospective interventional study conducted over a period of two years in the Department of Burns, Plastic and Maxillofacial Surgery, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospitals, New Delhi, India, involving patients presenting with fingertip amputations. A total of 39 patients presenting with Allen zone II and III amputations were included in the study. A total of 13 patients underwent BV-YRA Flap, 13 patients underwent HDI Flap and 13 patients had CRF Flap for fingertip amputation reconstruction. The authors compared the BV-YRA Flap, the HDI Flap and the CRF Flap for fingertip reconstruction. The final outcome was assessed at 12 months. Assessments were done for sensory recovery by the 2-Point Discrimination (2-PD), cold intolerance by Cold Intolerance Symptom Severity (CISS), Range Of Motion (ROM) of the Distal Interphalangeal (DIP) joint by goniometer, aesthetic outcome by self-evaluation score and time-off work in days. Comparisons were performed using appropriate statistical parametric or non parametric tests. After four patients lost to follow-up postsurgery, 35 patients presenting with Allen zone II and III amputations were included in the study. A total of 13 patients underwent BV-YRA Flap, 12 patients underwent HDI Flap and 10 patients had CRF Flap for fingertip amputation reconstruction.
Results: The demographics of patients in the three groups were comparable. All the flaps survived. The 2-PD was significantly lower in the BV-YRA group than in the other two groups (p<0.05). Only two patients in the BV-YRA flap group reported cold intolerance, whereas all patients in the HDI and CRF groups reported mild cold intolerance. The BV-YRA flap group demonstrated significantly greater DIP and PIP joint mobility than the HDI and CRF flap groups (p<0.05). The aesthetic satisfaction score was significantly better in the BV-YRA group (3.6±0.6) compared to the HDI (1.9±0.79) and CRF (1.0±0.82) groups (p<0.05). The mean time-off work for patients in the BV-YRA, HDI and CRF groups was 20, 33.5 and 51.5 days, the difference was statistically significant (p<0.05).
Conclusion: The authors found that fingertip amputations treated with the BV-YRA flap had significantly better functional and aesthetic outcomes than those treated with HDI and CRF flaps.