Fingertip Amps, Finger and Extremity Flaps

Question 1

What flaps are used for coverage of the tibia?

Answer 1

Proximal- medial or lateral gastric
Middle- soleus
Distal- free flap

Question 2

What are the vascular pedicles that some common flaps are based on?

Answer 2

Fibula- peroneal a.
iliac crest- deep circumflex a.
Groin- superficial circumflex a.
Gracilis- medial femoral circumflex a.
Gastroc- sural

Question 3

The sural artery provides the vascular supply to which musculocutaneous flap?

Answer 3

Gastrocnemius

Question 4

How does the treatment of fingertip injuries with exposed bone differ in adults and children?

Answer 4

In pediatric patients can be treated by secondary intention; adults require revision amputation of coverage of exposed bone

Question 5

What are some technical tricks for revision amputation?

Answer 5

1) must ablate remaining nail matrix
2) if flexor or extensor tendon insertions cannot be preserve, disarticulate DIP joint
3) transect digital nerves and remaining tendons as proximal as possible
4) palmar skin is brought over bone and sutured to dorsal skin

Question 6

What flap options are available for fingertip options?

Answer 6

V-Y advancement: dorsal oblique
Cross finger flap: volar oblique; > 30yo
Thenar flap: volar oblique less than 30yo

Question 7

What size defect can be covered using a Moberg flap?

Answer 7

Less than 2cm; if >2cm can use first dorsal metacarpal artery (FDMA); NV island flap can cover up to 4cm

Question 8

How much can a scar lengthen using two-flap Z-plasty with 60° limbs?

Answer 8

75%; utilized in webspace contractures

Question 9

What type of skin grafts are indicated for volar and dorsal hand wounds?

Answer 9

Volar: FTSG
Dorsal: STSG