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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.

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

Stable skin coverage

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.

Injuries must also be


thought of in terms of
whether bone is exposed
and the angulations of
injury.

dorsal oblique and


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

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

The flap with connective tissue

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

The cutaneous flap plane of dissection


over the superficial surface of fascia

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

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

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.

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