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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 26  |  Issue : 3  |  Page : 128-130

Reconstruction of traumatic finger defects with split groin flap


Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Atatürk Training and Research Hospital, Ankara, Turkey

Date of Web Publication2-Jul-2018

Correspondence Address:
Mehmet Sonmez
Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Atatürk Training and Research Hospital, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_34_18

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  Abstract 

Pedicled groin flap is a treatment option in use for hand defects caused by trauma or other etiologic factors. It gains particular significance in multiple finger defects, especially in those with one intact digital artery or in hand defects that cannot be reconstructed with regional flaps. Although several studies have reported the use of split groin flap in the reconstruction of such defects, no previous study has reported cases where specifically complex volar defects of two adjacent fingers. We present the reconstruction of two adjacent fingers with a split groin flap. A 22-year-old male patient, active smoker, admitted to our clinic for second and third finger volar complex defects in his right hand due to traffic accident. It was contaminated with asphalt tar, and bone and flexor tendons were exposed. After initial debridement, the patient was followed up by outpatient treatment until an appropriate wound surface was obtained. Then, split groin flap was planned. The flap was divided in the 3rd postoperative week and adapted to the wounds. In the follow-up period, no flap loss occurred, and the patient did not require any flap revision or additional surgery. Split groin flap is a reliable flap option for complex volar finger defects.

Keywords: Axial flap, complex finger defect, split groin flap


How to cite this article:
Sonmez M, Çil Y. Reconstruction of traumatic finger defects with split groin flap. Turk J Plast Surg 2018;26:128-30

How to cite this URL:
Sonmez M, Çil Y. Reconstruction of traumatic finger defects with split groin flap. Turk J Plast Surg [serial online] 2018 [cited 2021 Nov 29];26:128-30. Available from: http://www.turkjplastsurg.org/text.asp?2018/26/3/128/235791


  Introduction Top


Groin flap was first defined by McGregor and Jackson in 1972 as a reliable flap with axial blood flow, which later began to be used for the reconstruction of acute traumatic complex defects [1] and subsequently also applied to reconstruct traumatic hand defects. [2] Despite the current developments in the free flap surgery and its widespread usage, groin flap can be safely used in cases with technical difficulties and high-risk patients. Even though the technique of split groin flap was defined by Climo in 1978, it was not until later that it began to be used in routine applications. [3] Although a previous study has reported the use of split groin flap in several cases of hand defects involving both the dorsal and volar surfaces, [4] a review of the related literature has revealed that no publication is available reporting its use in complex volar soft-tissue defects of the fingers. Our report presents a case where we applied a split groin flap to reconstruct complex volar defects at different levels at two adjacent fingers.


  Case Report Top


A 22-year-old male patient, active smoker, admitted to our hospital for tissue defect at second and third fingers due to traffic accident. He had complex soft-tissue defects contaminated with tar and exposed bone and tendon at the level of distal interphalangeal joint of the second finger and tissue defects also contaminated with tar which, beginning at the mid-part of the proximal phalanx of the third finger and extending to the fingertip at the ulnar side, enclosed the half of the mid-axis of the finger with exposed flexor tendon and bone [Figure 1]. No bone fracture was observed. After informed consent was obtained from the patient, soft-tissue debridement was planned in the first instance, and foreign bodies and tar at the defects were removed. Then, the patient was followed up for 10 days by outpatient treatment, after which a split groin flap was planned to reconstruct the defects [Figure 2]. The superficial circumflex iliac artery was dissected and preserved, and the flap was elevated up to its medial side of the sartorius muscle. Then, it was splitted, as planned, keeping the artery being on the larger flap and adapted to the defects [Figure 3] and [Figure 4]. The operation was concluded by applying retention sutures to prevent tension on the flaps. The elbow flexion was provided by padding of the axilla. In the follow-up of the patient, the dressing was relaxed in a controlled manner. Beside the maceration on the palmar side, no problems were observed during the follow-up of the period. At the 3 rd postoperative weeks, the groin flap was divided and adapted to the defects without any debulking procedure [Figure 5]. Since the flaps were very thin compared to the body structure of the patient, there was no need to perform an additional thinning of the flaps. In the postoperative follow-up period after the division of the groin flap, a minor problem in venous circulation occurred in the flap on the second finger, which later spontaneously recovered. A physical rehabilitation treatment was started 1 week after the surgery. We observed that the flaps were well adapted to the fingers in the late period. Hair growth and pigmentation were also observed, though with no need for a revisional surgery [Figure 6].
Figure 1: The view of the defects before the debridement

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Figure 2: The design of the flaps

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Figure 3: Designing of flaps

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Figure 4: Splitting the flaps

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Figure 5: Adaptation of the flaps

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Figure 6: The postoperative view of the flap

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  Discussion Top


Even though several studies have so far been performed reporting various modifications of the groin flap, previous study has reported no cases where complex volar defects at two adjacent fingers were constructed by groin flap.

Splitting the groin flap requires no additional surgery when it is used in multiple finger defects. [5] On the other hand, it has no significant disadvantage in comparison to conventional tube flaps. The flap can also be widened and adapted to a third finger.

A visible scar formation and thickness are the disadvantages of the paraumbilical perforator flap which was proposed as an alternative method to the groin flap. [6] We also do not prefer the paraumbilical flap due to possible problems at its donor site.

In related literature, there have been a number of researchers who have reported a series of cases where free flaps were used for finger defects. However, since a single digital artery and vein are used for anastomosis in this technique, it requires that the other digital artery and veins must also be intact. [7] On the other hand, the results are similar to those obtained with pedicled groin flap. [7] This condition restricts the usage of free groin flap in multiple finger defects. Immobilization using a plaster cast, axillary block anesthesia, and external fixation are some of the methods to provide the stabilization of the groin flap [8],[9] In our case, we used a method based on a conventional process: the flap was adapted to the groin area by applying a dressing filling at the armpit area and retention sutures at fingertips. The other fingers were mobilized in a controlled mobilization program, and we were not faced with any problem about the patient's compliance to rehabilitation. The decision as to which immobilization method should be preferred primarily depends on the condition of the patient as well as the experience and practical knowledge of the surgeon.

Splitting the groin flap along the lateral edge of the sartorius muscle does not cause any perfusion problem. [4] We believe that we need more clinical case studies in this subject.


  Conclusion Top


We believe that the split groin flap can be a reliable option in complex volar defects of the fingers.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
McGregor IA, Jackson IT. The groin flap. Br J Plast Surg 1972;25:3-16.  Back to cited text no. 1
[PUBMED]    
2.
Wray RC, Wise DM, Young VL, Weeks PM. The groin flap in severe hand injuries. Ann Plast Surg 1982;9:459-62.  Back to cited text no. 2
[PUBMED]    
3.
Climo MS. Split groin flap. Ann Plast Surg 1978;1:489-92.  Back to cited text no. 3
[PUBMED]    
4.
Brooks TM, Jarman AT, Olson JL. A bilobed groin flap for coverage of traumatic injury to both the volar and dorsal hand surfaces. Can J Plast Surg 2007;15:49-51.  Back to cited text no. 4
[PUBMED]    
5.
Rasheed T, Hill C, Riaz M. Innovations in flap design: Modified groin flap for closure of multiple finger defects. Burns 2000;26:186-9.  Back to cited text no. 5
[PUBMED]    
6.
Naduthodikayil P, Bhandari L, Sreedhar SL. Pedicled oblique para-umbilical perforator (OPUP) flap for upper limb reconstruction. J Hand Surg Asian Pac Vol 2016;21:229-33.  Back to cited text no. 6
[PUBMED]    
7.
Tare M, Ramakrishnan V. Free 'mini' groin flap for digital resurfacing. J Hand Surg Eur Vol 2009;34:336-42.  Back to cited text no. 7
    
8.
Bekler H, Beyzadeoglu T, Mercan A. Groin flap immobilization by axillary brachial plexus block anesthesia. Tech Hand Up Extrem Surg 2008;12:68-70.  Back to cited text no. 8
[PUBMED]    
9.
Sheena Y, McCulloch R, Evriviades D. External fixator immobilisation of a pedicled groin flap. Ann R Coll Surg Engl 2014;96:75.  Back to cited text no. 9
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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Abstract
Introduction
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Discussion
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