Clinical outcome of volar advancement flap for fingertip amputations

Abstract

<p>Introduction:<br></p><p>Local flap reconstruction for fingertip amputations were commonly performed to preserve length, improve cosmesis and function. Moberg volar advancement flap was classically described for coverage of thumb defect, but its use in fingertip injury, especially in lesser digits other than thumb, was seldom reported. Our study aims at evaluating the clinical outcome of volar advancement flap for fingertip amputations.</p><p><br></p><p>Methods:<br></p><p>25 patients with volar advancement flap performed for fingertip amputation reconstruction in a single centre from 2015 to 2021 were recruited into the study. Retrospective review of patient demographics, injury details and short-term functional outcome was performed using patient records. Long-term functional outcome was assessed with QuickDASH score, grip strength measurement and objective sensory assessment.</p><p><br></p><p>Results:<br></p><p>Volar advancement flaps were performed in all five fingers among the study cohort, with 72% being performed in lesser digits. Common complications include infection (12%) and hook nail deformity (8%). No flap necrosis or failure was noted. Fixed flexion deformity of terminal interphalangeal joint was observed in 19% of patients, with the mean extension deficit at 3.2 deg (range 0-20). Mean monofilament test at pulp is 3.74. Mean percentage power grip and pincer grip were 79.5% and 65.4% of non-injured hand respectively. Median QuickDASH score was 3.4 (range 0-18.2). </p><p><br></p><p>Conclusion:<br></p><p>Volar advancement flap carries a risk of mild fixed flexion deformity, but is otherwise a good surgical reconstruction option in selected cases with good functional outcome and requires no microsurgical expertise.</p>