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European Journal of Plastic Surgery

Published in:

26-09-2023 | Original Paper

Soft tissue reconstruction with small free flaps in hand and finger defects

Authors: Alper Aksoy, Yavuz Tuluy, Emin Sır, M Baver Acaban

Published in: European Journal of Plastic Surgery | Issue 6/2023

Abstract

Background

With the technological and technical improvements in microsurgery, the defect reconstruction with free flaps has increased in hand surgery. In this study, we aimed to evaluate the results of free posterior interosseous perforator (PIAP) flap, free superficial palmar branch of the radial artery (SUPBRA) flap and hypothenar free perforator flap in hand and finger defects.

Methods

A total of 58 patients who were operated between 2017 and 2021 were included in the study. Hand defects of patients occurred due to industrial accidents and reconstructed by using free SUPBRA, free PIAP and hypothenar free perforator flaps were included into the study. Demographics of patients, characteristics of the flaps and complications were evaluated retrospectively.

Results

Twenty eight free SUPBRA flap, 12 hypothenar free perforator flap and 18 free PIAP flap surgeries were performed. Static and dynamic two-point discrimination tests were evaluated and acceptable results were obtained. Donor site scar was compared with the non-operated side by using visual analogue scale (VAS). The median VAS values were calculated as 8 for three different flaps. Total necrosis developed in 3 patients. Other complications are hematoma, partial necrosis and wound dehiscence in the donor area.

Conclusion

We obtained good aesthetic and functional results by using free small flaps in hand and finger defects. As the experience of perforator-to-perforator anastomosis increases, the use of these flaps in the reconstruction of hand defects is increasing.

Level of evidence: Level III, Therapeutic.

Tempest MN (1952) Cross-finger flaps in the treatment of injuries to the finger tip. Plast Reconstr Surg (1946). 9(3):205–22. https://doi.org/10.1097/00006534-195203000-00002CrossRefPubMed

Akdağ O, Yıldıran G, Sütçü M, Karameşe M (2018) Posterior interosseous flap versus reverse adipofascial radial forearm flap for soft tissue reconstruction of dorsal hand defects. Ulus Travma Acil Cerrahi Derg 24(1):43–48. https://doi.org/10.5505/tjtes.2017.41196CrossRefPubMed

Dogra BB, Singh M, Chakravarty B, Basu S (2006) Posterior interosseous artery flap for hand defects. Med J Armed Forces India 62(1):33–35. https://doi.org/10.1016/S0377-1237(06)80150-4CrossRefPubMedPubMedCentral

Chang SC, Chen SL, Chen TM, Chuang CJ, Cheng TY, Wang HJ (2004) Sensate first dorsal metacarpal artery flap for resurfacing extensive pulp defects of the thumb. Ann Plast Surg 53(5):449–454. https://doi.org/10.1097/01.sap.0000137134.15728.ddCrossRefPubMed

Checcucci G, Galeano M, Zucchini M, Zampetti PG, Ceruso M (2014) Reverse flow first dorsal metacarpal artery flap for covering the defect of distal thumb. Microsurgery 34(4):283–286. https://doi.org/10.1002/MICR.22198CrossRefPubMed

Lo S, Sebastin S, Tsai L, Pin PY (2007) Reverse radial forearm flap peforator used in digital revascularization. Hand 2(3):155–158. https://doi.org/10.1007/s11552-007-9040-8CrossRefPubMedPubMedCentral

Koshima I, Moriguchi T, Etoh H, Tsuda K, Tanaka H (1995) The radial artery perforator-based adipofascial flap for dorsal hand coverage. Ann Plast Surg 35(5):474–479. https://doi.org/10.1097/00000637-199511000-00005CrossRefPubMed

Sebastin SJ, Mendoza RT, Chong AKS, Peng YP, Ono S, Chung KC, Lim AYT (2011) Application of the dorsal metacarpal artery perforator flap for resurfacing soft-tissue defects proximal to the fingertip. Plast Reconstr Surg 128(3):166e–178e. https://doi.org/10.1097/PRS.0b013e318221ddfa

Chang SM, Hou CL, Zhang F, Lineaweaver WC, Chen ZW, Gu YD (2003) Distally based radial forearm flap with preservation of the radial artery: anatomic, experimental, and clinical studies. Microsurgery 23(4):328–337. https://doi.org/10.1002/micr.10155CrossRefPubMed

10.

Regmi S, Gu JX, Zhang NC, Liu HJ (2016) A systematic review of outcomes and complications of primary fingertip reconstruction using reverse-flow homodigital island flaps. Aesthetic Plast Surg 40(2):277–283. https://doi.org/10.1007/s00266-016-0624-yCrossRefPubMed

11.

Baumeister S, Menke H, Wittemann M, Germann G (2002) Functional outcome after the Moberg advancement flap in the thumb. J Hand Surg Am 27(1):105–114. https://doi.org/10.1053/jhsu.2002.30921CrossRefPubMed

12.

Nakanishi A, Omokawa S, Iida A, Kaji D, Tanaka Y (2015) Predictors of proximal interphalangeal joint flexion contracture after homodigital island flap. J Hand Surg Am 40(11):2155–2159. https://doi.org/10.1016/j.jhsa.2015.08.008CrossRefPubMed

13.

Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F (2014) Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg 41(3):325–359. https://doi.org/10.1016/j.cps.2014.04.004CrossRefPubMed

14.

Omokawa S, Ryu J, Tang JB, Han J (1997) Vascular and neural anatomy of the thenar area of the hand: its surgical applications. Plast Reconstr Surg 99(1):116–121. https://doi.org/10.1097/00006534-199701000-00018CrossRefPubMed

15.

Cavadas PC (2001) Posterior interosseous free flap with extended pedicle for hand reconstruction. Plast Reconstr Surg 108(4):897–901. https://doi.org/10.1097/00006534-200109150-00012CrossRefPubMed

16.

Kim KS, Kim ES, Hwang JH, Lee SY (2013) Fingertip reconstruction using the hypothenar perforator free flap. J Plast Reconstr Aesthetic Surg 66(9):1263–1270. https://doi.org/10.1016/j.bjps.2013.05.006CrossRef

17.

Koshima I, Nanba Y, Tsutsui T et al (2004) Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg 113(1):233–240. https://doi.org/10.1097/01.PRS.0000095948.03605.20CrossRefPubMed

18.

Kueckelhaus M, Gebur N, Kampshoff D et al (2022) Initial experience with the superficial circumflex iliac artery perforator (SCIP) flap for extremity reconstruction in Caucasians. J Plast Reconstr Aesthetic Surg 75(1):118–124. https://doi.org/10.1016/j.bjps.2021.05.069CrossRef

19.

Narushima M, Iida T, Kaji N et al (2016) Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthetic Surg 69(6):827–834. https://doi.org/10.1016/j.bjps.2016.03.005CrossRef

20.

Bhadkamkar MA, Wolfswinkel EM, Hatef DA et al (2014) The ultra-thin, fascia-only anterolateral thigh flap. J Reconstr Microsurg 30(9):599–605. https://doi.org/10.1055/s-0033-1361843CrossRefPubMed

21.

Adani R, Tarallo L, Marcoccio I, Cipriani R, Gelati C, Innocenti M (2005) Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 116(2):467–473. https://doi.org/10.1097/01.prs.0000173059.73982.50CrossRefPubMed

22.

Javaid M, Cormack GC (2003) Anterolateral thigh free flap for complex soft tissue hand reconstructions. J Hand Surg Br 28(1):21–27. https://doi.org/10.1054/jhsb.2002.0863CrossRefPubMed

Title: Soft tissue reconstruction with small free flaps in hand and finger defects
Authors: Alper Aksoy
Yavuz Tuluy
Emin Sır
M Baver Acaban
Publication date: 26-09-2023
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Plastic Surgery / Issue 6/2023
Print ISSN: 0930-343X
Electronic ISSN: 1435-0130
DOI: https://doi.org/10.1007/s00238-023-02128-3

At a glance: The STEP trials

Springer Medicine

Soft tissue reconstruction with small free flaps in hand and finger defects

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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