Reconstructive Timing of Nail Preserved Fingertip Injury With Reverse Digital Artery Island Flap

Area of Science:

• Hand surgery
• Reconstructive surgery
• Microsurgery

Background:

• Reverse digital artery island flap (RDAIF) is a reconstructive technique.
• Outcomes of RDAIF in primary versus secondary reconstruction after failed digital replantation or composite grafting are compared.
• 42 patients (18 primary, 24 secondary) were retrospectively analyzed.

Purpose of the Study:

• To compare the functional outcomes of primary and secondary RDAIF for fingertip reconstruction.
• To identify factors influencing postoperative range of motion and patient satisfaction.

Main Methods:

• Retrospective analysis of 42 patients undergoing RDAIF.
• Evaluation of preoperative demographics and injury details.
• Assessment of postoperative outcomes including joint range of motion, flap sensation, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score, and patient satisfaction.

Main Results:

• No significant demographic differences between primary and secondary groups, except for waiting days.
• Similar sensory recovery and patient satisfaction in both groups.
• Primary reconstruction group showed superior range of motion (DIP, PIP, total active motion) and lower Quick-DASH scores.
• Older age, subzone III injury, and secondary reconstruction were associated with poorer range of motion.

Conclusions:

• Secondary reconstruction is linked to a higher incidence of joint contracture.
• Primary RDAIF reconstruction is recommended for fingertip amputations, particularly in older individuals, to achieve optimal functional results.
• Early surgical intervention is crucial for maximizing postoperative range of motion.