Cross Finger Flap 3s3f1k

Cross Finger Flap Deny Hermana Hand subdivision Department of Orthopedic and Traumatology UNPAD

Finger tip injury defined as those injuries occurring distal to the insertion of the flexor and extensor tendons.  most common injuries of the hand and can lead to a significant functional and cosmetic deficit if not treated appropriately. 

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The fingertip is the end organ for touch and is richly supplied with special sensory receptors that enable the hand to relay the shape, temperature, and texture of an object.

goals of reconstruction. 

Restoration of sensibility

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Stable skin coverage

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Adequate padding

Patient-related factors that should be considered to determine treatment Age  Occupation  Sex  Race  General health 

Injury-related factors

associated nail bed injuries  angle of injury  bone exposure  digit injured  concomitant injuries. 

CLASSIFICATION 

Allen has classified fingertip injuries into four types based on the level of injury

Type 1injuries involve only the pulp,  Type 2 injuries involve the pulp and nail bed.  Type 3 injuries include partial loss of the distal phalanx  Type 4 injuries are proximal to the lunula. 

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Injuries must also be thought of in of whether bone is exposed and the angulations of injury.

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dorsal oblique and transverse injuries are more suited to local flaps. Volar oblique flaps often require a regional flap.

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Management of finger tip injury Healing by secondary intention  Primary closure and revising amputation  Skin Graft  Flap 

Classification of the flap Base on :  Vascular anatomy  Method of utilization  Component tissue

Vascular anatomy 

The axial pattern flap

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The flap with connective tissue

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The musculocutaneus flap

Utilization Free flap  Peninsula flap  Island flap 

Component tissue The Fascial flap  including the deep fascia and thin layer of subcutaneous tissue  Subcutaneous flap  which dissected at sub dermal and suprafacial level, .This show as axial pattern vascularization 

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The cutaneous flap plane of dissection over the superficial surface of fascia

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The faciocutaneous flap  elevate end block with the skin the subcutaneous tissue and deep fascia

Flaps Sorted by Composition Random Pedicle Skin Flaps Vascular Pedicle Skin Flaps

Free Skin Flaps

Neurovascular Skin Flaps Composite Flaps

Thenar Cross finger Dorsal metacarpal Digital Artery Flaps Flag Flaps Dorsal metacarpal Radial artery Palmar advancement Posterior interosseous Lateral arm Free Thenar Free Radial Forearm Lateral arm Scapular/Parascapular Free Toe pulp Digital Neurovascular Island Pollicization "On top" Plasty Free finger transfer Toe flaps Nail Flaps

Cross-finger flap

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Originally termed the transdigital flap by Gurdin and Pangman in 1950

indication Finger tip injury especially on palmar side  Finger tip injury with expose -tendon -neurovascular -bone 

Contraindication       

Old patient >50 years old Arthritis of the finger Tendency to stiff Infection of the finger Patient with vasospastic ec Burger and Raynaud Epileptic or seizure Mental disorder

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Create a template for the defect dissect from the midlateral line of the lateral aspect of the adjacent finger to the midlateral line medially as required

Leave the paratenon intact to allow skin grafting of the donor site.  Also leave undisturbed the dorsal veins within the flap.  After the flap is raised, deflate the tourniquet. Obtain hemostasis to prevent hematoma formation. 

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Inset the flap and trim appropriately Suture the flap into the recipient finger defect, using an interrupted half-buried mattress monofilament suture (6-0 or 7-0).

Cover the donor site with a full-thickness skin graft.  Secure the skin graft with a bolster dressing and immobilize the digits in a position that places the least tension on the flap.  This is usually in the intrinsic plus position 

Reverse Cross-Finger Flap

The reverse cross-finger flap is more commonly used for dorsal finger defect

Design the flap with its base at the midaxial line of the middle phalanx of the donor finger.

•Elevate the skin of the donor finger as a full-thickness skin graft and separate from the subcutaneous tissues. The base of this skin is opposite to the defect •. Elevate the subcutaneous tissue on the dorsum of the donor finger as a flap, with its base hinged

adjacent to the defect, leaving the paratenon again intact Inset this flap into the defect and sew the skin back over the donor site.

Then create skin graft for the flap of subcutaneous tissue that has been transferred to the recipient finger defect. Apply a bolus dressing. Place the skin graft over the transferred subcutaneous tissue

Flap can be divided after 10- 14 days  Rehabilitation program immediately after separated the flap 

Multiple factors contribute to flap failure. Preoperative causes  Poor flap design  Inadequate flap size,  Additionally, patient-related factors such as smoking, hypertension, and poor overall health

Intra operative causes  Technical errors such as injuring the blood supply during dissection, creating too much tension on the flap, or twisting or kinking the flap pedicle can cause flap ischemia and necrosis.

Postoperative causes  Hematoma can cause pressure on the flap and lead to necrosis.  Infection also can cause partial or complete flap necrosis. The donor site is another potential source of complications 