The Lateral Proximal Phalanx Flap for Contractures and Soft Tissue Defects in the Proximal Interphalangeal Joint

摘要

Skin contractures in fingers can cause significant skin shortening, leading to major defects at contracture release. This problem often affects the proximal interphalangeal (PIP) joints in both the dorsal and palmar skin, and at present, there is no ideal method to replace the lost skin. The same principle applies to traumatic skin loses in this area. Total skin grafts can tend to contract, and thus could not be the best choice for tendon or neurovascular bundle exposition.1,5 For Dupuytren disease, some surgeons use the McCash technique waiting for secondary intention closures; however, this approach requires a long splinting time in extension. We have found descriptions of rotation flaps, homodigital and heterodigital flaps, and combinations of lateral transposition flaps taken from the proximal and middle phalanxes that have been used to achieve the complete closure of defects in the PIP joint.1,7 Such approaches, although successful, are usually complex, require multiple surgeries, and demand large incisions in the injured finger and/or healthy areas in other fingers, increasing regional morbidity. The lateral regions of fingers are very rich in arterial anastomosis6; they are usually protected from burns and able to retain healthy skin and subcutaneous tissues. Furthermore, the relative skin excess in this area allows for primary closure if used as a donor site.1,5,7 With this in mind, we have designed a new surgical technique calling for a flap to be taken from the lateral side of the proximal phalanx with a distal pivot point in the PIP joint. This approach can be easily modified for either the dorsum or the palm to cover any defects in this location within a single surgery without harming the adjacent fingers while still achieving a reliable vascular pedicle and minimal sequelae in the donor area.