Dorsal Metacarpal Adipofascial Flaps for Palmar Finger and Hand Reconstruction

Reconstruction of the Palmar Defect of the Hand with a Sensory Medial Plantar Artery Flap

Background

There are many approaches to repair the palmar defect of the hand, but due to the complex tissue structure, versatile functions, and high restoration demands, the repair of the palmar defect of the hand has always been a difficult task. Choosing suitable flaps to repair this kind of injury is always a tough challenge for the reconstructive surgeon because of the limitation of the number of arteries in the recipient hand and high restoration demands. The sensory medial plantar artery flap is considered as the ideal choice to repair the palmar defect of the hand. Based on this technique, in the current study, we used the free sensory medial plantar artery flap to reconstruct the palmar defect of the hand and obtained satisfactory results. The purpose of this study was to review the use of the sensory medial plantar artery flap for the reconstruction of the palmar defect of the hand.

Method

From January 2019 to December 2020, nine patients with the palmar defect of the hand underwent extremity reconstruction by a sensory medial plantar artery flap. The indications for this surgery were that the palmar defect of the hand need to be reconstructed and both anterior and posterior tibial arteries should be free-flowing. Patients who had systemic diseases such as diabetes millitus, vascular diseases, heavy smoking histories, and injuries of the donor site were ruled out for the surgery.

Results

Nine patients were successfully treated by using a sensory medial plantar artery flap, with a mean age of 39.44 (range 19–58) years. Five of the patients were male and the remaining four were female. Seven of them had a machine crush, and the other two suffered thermal injury. In all cases, reconstruction was performed during the second stage of treatment. All flaps survived completely, and all of the donor sites healed well in Stage 1, except for one case of ischaemic skin necrosis due to tight sutures, which healed after suture removal.

Conclusion

Our experience showed that the free sensory medial plantar artery flap was an alternative for one-stage reconstruction of the soft-tissue defect in the palm of the hand. This flexible approach not only repaired the soft-tissue defect, but also offered a satisfactory recovery of the sensory of the palm with minimal donor site morbidity.

Repair of a palmar soft tissue defect of the proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

This article describes the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of the volar defects at the proximal interphalangeal joint. The flap was based on the first dorsal branch of the proper digital artery. From January 2007 to March 2009, 14 digits in 14 patients (10 males and 4 females) were treated. There were 5 index, 6 middle, 2 ring, and 1 little finger. All patients underwent surgery 2-9 hours (mean 5 hours) after injury. Soft tissue defects ranged in size from 1.2 × 1.7 cm to 2.1 × 2.3 cm (mean 1.7 × 2 cm). Flap size ranged from 1.5 × 1.7 cm to 2.4 × 2.7 cm (mean 2 × 2.4 cm). Mean pedicle length was 1.1 cm (range 0.8-1.4 cm). All flaps completely survived. At final follow-up from 24-29 months (mean 26 months), mean active motion arcs of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 84° (range 75-91°), 86° (range 65-100°) and 54° (range 32-80°), respectively. Our technique is useful and reliable for coverage of a palmar defect over the proximal interphalangeal joint.

Repair of dorsal defects over the middle phalanx and proximal interphalangeal joint with a transposition flap from the dorsum of the proximal phalanx

PURPOSE

We report the use of a transposition flap raised from the dorsum of the proximal phalanx for coverage of soft tissue defects on the dorsum of the middle phalanx and proximal interphalangeal joint involvement.

METHODS

From October 2005 to November 2008, we treated 16 digits in 16 patients in our unit. There were avulsion (n = 3), third-degree burn (n = 7), and crush (n = 6) injuries. The mean flap size was 2.3 × 1.8 cm (range, 1.8 × 1.7 cm to 2.6 × 2.3 cm). The mean pedicle length was 1.7 cm (range, 1.0-2.3 cm). At follow-up, we measured active joint motion. The scar pain at the donor site was determined by the patient's self-reported assessment. We measured cold intolerance using the self-administered Cold Intolerance Severity Score questionnaire.

RESULTS

All flaps survived completely. At the final follow-up after 2 years, the mean active motion of the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints were 90°, 105°, and 57°, respectively. All scars on the donor sites were painless. All patients were mildly cold intolerant.

CONCLUSIONS

This transposition flap raised from the dorsum of proximal phalanx is useful and reliable for coverage of a dorsal defect over the middle phalanx and proximal interphalangeal joint with minimal donor site morbidity.