Donor Finger Morbidity in Cross-Finger Flap: A Systematic Review and Meta-Analysis

Abstract

Background The morbidity of donor finger in a cross-finger flap has not received as much importance as the outcomes of the flap itself. The sensory, functional, and aesthetic morbidity of donor fingers, reported by various authors, are often contradictory to each other. In this study, objective parameters for the sensory recovery, stiffness, cold intolerance, cosmetic outcome, and other complications in the donor fingers, reported in the previous studies, are systematically evaluated.

Methods This systematic review is reported using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol and was registered with the International prospective register of systematic reviews (PROSPERO registration no. CRD42020213721). Literature search was done using “cross-finger,” “heterodigital,” “donor finger,” and “transdigital” words. Data regarding demography, patients' number and age, follow-up duration and outcomes of donor finger, including 2-point discrimination, range of motion (ROM), cold intolerance, questionnaires, etc. were extracted from included studies. Meta-analysis was performed using MetaXL and risk of bias was evaluated using Cochrane risk of bias tool.

Results Out of the total 16 included studies, 279 patients were objectively evaluated for donor finger morbidity. Middle finger was most frequently used as donor. Static two-point discrimination seemed to be impaired in donor finger in comparison to contralateral finger. Meta-analysis of ROM suggested that statistically there is no significant difference in ROM of interphalangeal joints in donor and control fingers (pooled weighted mean difference: −12.10; 95% confidence interval: −28.59, 4.39; I2 = 81%, n = 6 studies). One-third of donor fingers had cold intolerance.

Conclusion There is no significant effect on ROM of donor finger. However, the impairment that seems to be in sensory recovery and aesthetic outcomes needs to be further evaluated objectively.

Keywords

cross-finger flap - donor finger - morbidity - systematic review

• References

• 1 Gurdin M, Pangman WJ. The repair of surface defects of fingers by trans-digital flaps. Plast Reconstr Surg (1946) 1950; 5 (04) 368-371
• 2 Nishikawa H, Smith PJ. The recovery of sensation and function after cross-finger flaps for fingertip injury. J Hand Surg [Br] 1992; 17 (01) 102-107
• 3 Woon CY, Lee JY, Teoh LC. Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery. Ann Plast Surg 2008; 61 (04) 385-391
• 4 Rabarin F, Saint Cast Y, Jeudy J. et al. Cross-finger flap for reconstruction of fingertip amputations: long-term results. Orthop Traumatol Surg Res 2016; 102 (4, Suppl): S225-S228
• 5 Sturman MJ, Duran RJ. Late results of finger-tip injuries. J Bone Joint Surg Am 1963; 45: 289-298
• 6 Ekinci Y, Gürbüz K. Is the cross-finger flap a good option at the extensor zone defect?. Jt Dis Relat Surg 2020; 31 (02) 267-272
• 7 Paterson P, Titley OG, Nancarrow JD. Donor finger morbidity in cross-finger flaps. Injury 2000; 31 (04) 215-218
• 8 Koch H, Kielnhofer A, Hubmer M, Scharnagl E. Donor site morbidity in cross-finger flaps. Br J Plast Surg 2005; 58 (08) 1131-1135
• 9 Erken HY, Akmaz I, Takka S, Kiral A. Reconstruction of the transverse and dorsal-oblique amputations of the distal thumb with volar cross-finger flap using the index finger. J Hand Surg Eur Vol 2015; 40 (04) 392-400
• 10 Wang B, Zhang X, Jiang W, Ma T, Li H, Wang H. Reconstruction of distally degloved fingers with a cross-finger flap and a composite-free flap from the dorsum of the second toe. J Hand Surg Am 2012; 37 (02) 303-309 , 309.e1–309.e4
• 11 Feng SM, Gu JX, Liu HJ. et al. Treatment of distal fingertip degloving injuries using a cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. J Reconstr Microsurg 2013; 29 (09) 623-630
• 12 Chen C, Tang P, Zhang L, Wang B. Treatment of fingertip degloving injury using the bilaterally innervated sensory cross-finger flap. Ann Plast Surg 2014; 73 (06) 645-651
• 13 Shao X, Chen C, Zhang X, Yu Y, Ren D, Lu L. Coverage of fingertip defect using a dorsal island pedicle flap including both dorsal digital nerves. J Hand Surg Am 2009; 34 (08) 1474-1481
• 14 Lee JYL, Teoh LC, Seah VWT. Extending the reach of the heterodigital arterialized flap by cross-finger transfer. Plast Reconstr Surg 2006; 117 (07) 2320-2328
• 15 Chitta M, Malathi L, Joseph A. Cross-finger flap to the thumb: quest for an alternate donor. Indian J Plast Surg 2020; 53 (02) 287-292
• 16 Patil RK, Chavre S. Distally based cross-finger flaps for amputation stumps in avulsion amputations. Indian J Plast Surg 2012; 45 (03) 504-511
• 17 Zhao J, Abdullah S, Li WJ, Appukuttan A, Tien HY. A novel solution for venous congestion following digital replantation: a proximally based cross-finger flap. J Hand Surg Am 2011; 36 (07) 1224-1230
• 18 Chen C, Tang P, Zhang L. Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap. J Plast Reconstr Aesthet Surg 2015; 68 (07) 990-994
• 19 Kim DH, Seo KB, Lee SH, Lee HJ, Kang HJ. Reverse digital artery cross-finger flap for reconstruction of failed finger replantation. J Orthop Surg (Hong Kong) 2019; 27 (01) 2309499018816773
• 20 Al-Qattan MM. Time of return back to work and complications following cross-finger flaps in industrial workers: comparison between immediate post operative mobilization versus immobilization until flap division. Int J Surg Case Rep 2018; 42: 70-74