gms | German Medical Science

Objectives/Interrogation: The fingertip is one of the regions most often exposed to trauma of the hand. Loss of the tactile function and capability of the pinch can affect the hand functions irreversibly and seriously.

Reconstruction with glabrous and sensation skin is essential for ideal resurfacing of fingertip after injuries. The purpose of this study is to analyze the palmar pivot flap as an option for fingertip and pulp defect in selected cases.

Methods: We used the palmar pivot flap to repair fingertip and pulp defect in 12 patients (9M, 3F) with age ranging from 29 to 52 years (mean 38y) There were two cases of index finger, 6 middle finger injuries and 4 ring finger injuries. We observed oblique or transverse defect with or without bone exposure. The flap is an axial pattern flap based on the subcutaneous transverse branches of the digital artery. The flap is pivoted up to 90° in order to reach adjacent defect. The donor defect is limited to the same digit avoiding scars in different finger. The average size of affected area was 2 cm x 2 cm up to 2,5 cm x 3 cm. Eleven patients were treated in emergency. We never used skin graft to cover donor site, all healed primarly. Outcomes measured PIP and DIP range of motion, sensation, pain, cold intolerance, percussion tenderness and aesthetical result.

Results and Conclusions: All flaps survived. We achieved complete mobility of PIP joint (>95°) and DIP joint (>80°). Sensory recovery was demonstrated in all flaps after 8 weeks (mean 2 SPD was 6.4), no painful tips reported, 2 cases had mild cold intolerance, no mild percussion tenderness.

Only 1 patient was not satisfied with aesthetical appearance because onychodystrophy occurred.

The palmar pivot flap can provide sensate glabrous skin for the effective reconstruction of finger tip and pulp defects, resulting in aesthetically and good functional outcomes. Because of simple technique procedure, it may be employed in out patient surgery under local anesthesia.