Surgical Treatment of Three-Dimensional Flexion Contractures of the Proximal Interphalangeal Joints of the Long Fingers Using a Direct Lateral Skin-Fatty Digital Flap with Randomized Blood Supply

Objective. The purpose of the study was to evaluate the possibility of closing defects of the covering tissues that arise during the elimination of three-dimensional dermato-teno-arthrogenic contractures of the proximal interphalangeal joint using a direct lateral skin-fatty digital flap with randomized blood supply, and to develop a surgical approach enabling elimination of all contracture components and one-stage closure of palmar skin defects of the finger. The article presents the outcomes of surgical treatment of patients using the developed method. Materials and Methods. Fifteen patients with post-traumatic persistent three-dimensional dermato-teno-arthrogenic contractures of the proximal interphalangeal joints, affecting 18 long fingers, were under supervision. All patients underwent clinical, laboratory, and radiological examinations. All patients underwent reconstructive and restorative surgery on 18 long fingers: tenolysis, arthrolysis, tendon lengthening (if necessary), and closure of covering tissue defect, which arose during the surgery, with direct lateral skin-fatty digital flaps with randomized blood supply. Results. Outcomes of the surgical treatment for persistent dermato-teno-arthrogenic contractures of the proximal interphalangeal joint were evaluated according to standard orthopedic and surgical principles. Conclusions. Closure of soft-tissue defects over functionally significant structures of the finger is possible when using an “H”-shaped approach for tenolysis and arthrolysis, combined with the elevation and transposition of a direct lateral skin-subcutaneous digital flap with randomized blood supply. The technical simplicity and reliability of this method for closing palmar skin defects that occur during the elimination of persistent three-dimensional contractures of the proximal interphalangeal joints using a direct lateral digital skin-subcutaneous flap with randomized blood supply allows it to be recommended for use.