Fingertip reconstruction by palmar bipedicular island flap in long fingers (modified neurovascular Tranquilli–Leali flap): A dual-center study

• Published in: Hand surgery and rehabilitation 2020-02, Vol.39 (1), p.59-64
• Main Authors: Sérane-Fresnel, J., Lafosse, T., Amsallem, L., Chaves, C., Delpit, X., Chassat, R., Masméjean, E.H.
• Format: Article
• Language: English
• Subjects: Amputation digitale; Digital amputation; Flap; Lambeau; Nail; Ongle; Pulp reconstruction; Reconstruction de pulpe
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2019.11.003

When bone is exposed, fingertip defects may require a flap procedure. Many types are available, with little consensus about which one is best. But each one has its own disadvantages: esthetic (claw nail deformity), neurological (sensory disorders) or functional (stiffness). The purpose of this study was to evaluate a palmar bipedicular island flap (our modification of the Tranquilli-Leali flap) for fingertip reconstruction. We retrospectively analyzed the prospective data of 42 patients with a mean follow up of 16.4 months (6–30 months) operated in two hospital facilities. Thirty-three patients were men. Mean age was 39.5 years (12–83 years) and 24 (57.1%) were smokers. In 23 cases (54.8%), the trauma was work-related. A crush mechanism was identified in 29 patients (69%). According to Allen's classification of fingertip injuries, there were 26 cases of stage II, 14 cases of stage III and 2 cases of stage IV. All procedures were performed on an emergency basis, within 24 hours of the trauma. No claw nail deformity was observed. The mean discrimination in the Weber test was 3.8mm (2–6mm). The mean Total Active Motion (TAM) was 268.3° (255–275°). The patient satisfaction was graded at 8.7 on a 10-point scale. Results were considered as excellent in 15 cases and good in 23 cases. The modified palmar bipedicular island flap makes the old Tranquilli–Leali flap – which has a poor reputation in the hand surgeon community—simpler and safer to use. This flap restores proper balance between skin, bone and nail in Allen stage II and III fingertip amputations. L’utilisation de lambeau de couverture dans les pertes de substance pulpaires avec exposition osseuse est encore largement admise. Les auteurs présentent une modification du lambeau de Tranquilli–Leali. L’objectif de cette étude était d’en évaluer le résultat des points de vue sensitif, esthétique et fonctionnel. L’analyse rétrospective de données portait sur 42 lambeaux dits modifiés avec un recul moyen de 16,4 mois (6–30 mois) opérés dans 2 centres. Trente-trois étaient des hommes. L’âge moyen était de 39,5 ans (12–83 ans) et 24 (57,1 %) étaient fumeurs. Dans 23 cas (54,8 %), l’accident était lié au travail; il correspondait à un écrasement dans 29 cas (69 %). Selon la classification d’Allen, il y avait 26 stade II, 14 stade III et 2 stade IV. Aucun ongle en griffe n’a été observé. La discrimination moyenne au test de Weber était à 3,8mm (2–6mm). La total active motion (TAM) moyenne était de 268,3° (255°–275°)