Publication:

Early outcome of distally based C-ring cross finger flap for the reconstruction of degloved amputation stumps and volar and dorsal defects of the fingers

Background Degloved amputation stumps and volar or dorsal finger defects are challenging to reconstruct. The distally based C-ring cross finger flap offers larger size and wider rotation than conventional flaps, but prospective outcome data are limited.

Methods This prospective observational study included 40 patients undergoing reconstruction of degloved amputation stumps or volar/dorsal finger defects using the distally based C-ring cross finger flap at Dhaka Medical College Hospital (December 2022-January 2024). Outcomes assessed included flap dimensions, viability (necrosis: marginal 20%, complete), flap-related complications (venous congestion, infection, wound dehiscence), donor site morbidity (infection, re-skin grafting) and range of motion (ROM) of proximal (PIP) and distal (DIP) interphalangeal joints. Overall functional outcome was classified as good, satisfactory or poor.

Results Mean flap area was 6.46 cm² (wound area 5.11 cm²). No necrosis occurred in 57.5%; marginal necrosis in 22.5%, partial in 10%, significant in 7.5%, complete loss in 2.5%. Venous congestion occurred in 25%, infection in 10%, wound dehiscence in 10%; 55% had no complications. Donor site morbidity was absent in 65%; infection and re-skin grafting each occurred in 17.5%. Full ROM was achieved in 100% of PIP joints and 97.5% of DIP joints. Overall outcome was good in 70%, satisfactory in 22.5%, and poor in 7.5%.

Conclusions The distally based C-ring cross finger flap is a reliable technique for reconstructing degloved amputation stumps and finger defects, providing adequate coverage, acceptable flap survival, manageable complications, low donor site morbidity and excellent joint mobility with 70% achieving good functional outcomes.