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Published on: May 23, 2025
Fingertip reconstruction by palmar bipedicular island flap in long fingers (modified neurovascular Tranquilli-Leali
J Sérane-Fresnel1, T Lafosse2, L Amsallem3
1Hand, upper limb and peripheral nerve service, Department of orthopedic surgery, Teaching European Hospital Georges Pompidou, Paris Descartes University, Sorbonne Paris Cité université, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France; SOS mains Trappes, Hôpital Privé de l'Ouest Parisien, 13, rue Castiglione-del-Lago, 78190 Trappes, France.
Abstract:
When bone is exposed, fingertip defects may require a flap procedure. Many types are available, with little consensus about which one is best. But each one has its own disadvantages: esthetic (claw nail deformity), neurological (sensory disorders) or functional (stiffness). The purpose of this study was to evaluate a palmar bipedicular island flap (our modification of the Tranquilli-Leali flap) for fingertip reconstruction. We retrospectively analyzed the prospective data of 42 patients with a mean follow up of 16.4 months (6-30 months) operated in two hospital facilities. Thirty-three patients were men. Mean age was 39.5 years (12-83 years) and 24 (57.1%) were smokers. In 23 cases (54.8%), the trauma was work-related. A crush mechanism was identified in 29 patients (69%). According to Allen's classification of fingertip injuries, there were 26 cases of stage II, 14 cases of stage III and 2 cases of stage IV. All procedures were performed on an emergency basis, within 24 hours of the trauma. No claw nail deformity was observed. The mean discrimination in the Weber test was 3.8mm (2-6mm). The mean Total Active Motion (TAM) was 268.3° (255-275°). The patient satisfaction was graded at 8.7 on a 10-point scale. Results were considered as excellent in 15 cases and good in 23 cases. The modified palmar bipedicular island flap makes the old Tranquilli-Leali flap - which has a poor reputation in the hand surgeon community-simpler and safer to use. This flap restores proper balance between skin, bone and nail in Allen stage II and III fingertip amputations.
