Lateral Zig-Zag Incision Approach for Reverse Digital Artery Island Flap

Lateral Zig-Zag Incision Approach for Reverse Digital Artery Island Flap

Department of Plastic and Reconstructive Surgery, Kanazawa Medical University Ishikawa, Japan

Kenichi Shimada,M.D. Ph.D

Introduction

The reverse digital artery island flap utilizing the transverse palmar branch of the interphalangeal joint reported by Kojima in 1985 is suited to moderate to severe damage to the finger pad. The skin flap is raised using a straight or zig-zag incision made at the mid-lateral aspect. The selection of one of these two approaches is based on the preference of the surgeon. In this report, postoperative contracture following these approaches is compared and the usefulness of the zig-zag incision is discussed.

Methodology

Straight and zig-zag, mid-lateral incision, flap-lifting approaches used in fingertip reconstruction were comparatively examined for 20 fingers of 19 patients, utilizing a reverse digital artery island flap.

Results

Straight incisions were made in 11 fingers and zig-zag incisions were made in 9 fingers. Skin contracture was observed in 5 cases involving a straight incision and in 1 case involving a zig-zag incision. Contracture of the proximal interphalangeal (PIP) joint was observed in 4 cases involving a straight incision but was not observed in any case involving a zig-zag incision. Thus, skin and PIP joint contracture tended to occur more readily following a straight incision compared with a zig-zag incision.

Discussion

A lateral zig-zag incision produces two triangular flaps on both sides of the wound. The incision can be designed simply and uses a suturing technique that resists reopening in conjunction with PIP joint flexion/extension, compared with that using a straight incision. Thus, prevention of postoperative scar contracture is possible and early rehabilitation can also be achieved. Additionally, reducing pressure placed on flap blood vessels is possible by using a triangular flap as a V-Y flap. A lateral zig-zag incision is a useful technique when raising reverse digital artery island flaps.