Background: Reverse homodigital artery island flap (RHDI) has been reported to have some postoperative complications. Cross-finger reverse digital artery island flap (CRDI), which is harvested from an adjacent intact finger, has been used to decrease these complications. This study aimed to provide a review of the CRDI procedure and compare the clinical outcomes of CRDI with those of RHDI.
Methods: RHDI has been performed for fingertip amputations with deficit of 1.5-2.5 cm before 2018, and CRDI has been performed since 2018. We assessed the functional and aesthetic outcomes, including finger length, nail deformity, finger motion, and Hand20 scores at the final follow-up.
Results: We identified 22 patients who underwent RHDI and 10 patients who underwent CRDI. The mean follow-up period was 10.3 ± 5.3 months. The median time required for wound healing were 47.0 days (IQR: 34.3-55.8 days) and 34.5 days (IQR: 29.3-44.3 days) in RHDI and CRDI, respectively. The hook nail deformity occurred significantly more frequently in RHDI compared to that in CRDI (40.9% vs. 0.0%, p = 0.03). Flexion contracture of the proximal interphalangeal joint greater than 15º was found to be significantly more in RHDI than in CRDI (36.4% vs. 0.0%, p = 0.04). The median postoperative total active motion of the donor site in CRDI was 278º (IQR: 260-280º). The median postoperative Hand20 scores were similar between the two groups.
Conclusion: CRDI was associated with superior clinical outcomes in terms of lower rates of postoperative flexion contracture and hook nail deformity, potentially making it a better option compared to RHDI.
Keywords: Cross-finger flap; Fingertip injury; Fingertip injury outcome score; Reconstruction surgery; Reverse island flap.
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