The free flap based on a single proximal perforator of the radial artery: ultrasonography study and clinical applications in reconstruction of soft tissue defects in finger

Case report of substantial reconstruction of second ray segment by osteo-tendo-cutaneous pedicled radial forearm flap

Introduction and importance: The hand is one of the most vital organ that the surgeon aims to preserve its function and natural appearance. Gunshot injuries are common, especially in a war zone, and unfortunately, they create complex wounds that are hard to reconstruct and infection is very common. In this article, we report rebuilding segment of index finger with a pedicled osteo-tendo-cutaneous radial forearm flap. Case presentation: A 50-year-old man-African with no past medical comorbidities, sustained trauma to his left index finger by high-velocity injury that led to composite tissue loss including metacarpal and proximal phalanx. After applying the initial irrigation and dressing to the wound, his hand was supported by a volar cast then he was referred to the hospital. The hand was examined at the operation room and the index finger was found to be hanged with a medial skin pedicle with necrotic and exposed bone and tendon. He underwent a session of debridement followed by reconstruction using a pedicled osteo-cutaneous radial forearm flap accompanied with metacarpophalangeal joint arthrodesis. Clinical discussion: A significant number of war-related hand injuries resulted in amputations because there were not enough facilities or doctors. While they are alternatives to free flap, abdominal and regional flaps won't yield the same outcomes. The second ray of the hand is reshaped using a radial flap, producing an acceptable result. Conclusion: The Radial forearm flap was used to reconstruct segment of index finger and fulfill our requirements, which include bone, tendon, and skin cover. Additionally, this is a simple and single stage procedure and micro-surgical equipment is not necessary.

Combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of a mid-distal adjacent finger defect: a retrospective study

PURPOSE

Assessing the clinical effectiveness of combining with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold to repair mid-distal defects in adjacent fingers.

METHODS

From September 2012 to April 2022, 21 patients with 42 mid-distal defects of adjacent fingers underwent treatment using combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold. The flaps size ranged from 2.1 cm * 1.6 to 4.9 cm * 3.2 cm. Follow-up evaluations included assessing function, sensation, and appearance, etc. of the injured fingers and donor areas.

RESULTS

All 42 flaps survived in 21 patients without any vascular crises, and the wounds healed in phase I. The mean follow-up time was 12.2 months (range 7-22 months). During follow-up, in injured fingers, according to the Michigan Hand Outcomes Questionnaire (MHOQ), the functional recovery and appearance were satisfactory; in Dargan Function Evaluation (DFE), the results were both "excellent" in fourteen patients, "excellent" and "good" in five patients, both "good" in one patient, "good" and "general" in one. In static two-point discrimination (2PD), the variation ranges from 4 to 9 mm in injured fingers and 6-10 mm in donor toes. Cold Intolerance Severity Score (CISS) is mild in all patients. The visual analogue score (VAS) showed no pain in the injured fingers and donor toes. No deformities or other complications were noted at the donor toes. According to Chinese Manchester Foot Pain and Disability Index (C-MFPDI), there was no morbidity on foot function in all donor areas.

CONCLUSION

The surgical procedure of combined with the first dorsal (plantar) metatarsal artery pedicle free bilobed flap with a cell scaffold for the repair of mid-distal adjacent fingers defect is highly satisfactory. This approach helps the injured fingers to achieve good function, sensibility and appearance, while also achieving satisfactory results in the donor toes.

Reconstruction of upper extremity soft tissue defects with free flaps

Aim: Many methods have been described in the literature for the reconstruction of upper extremity defects that may occur as a result of various etiological reasons. Among these methods, local or regional flaps are used quite frequently, and most defects can be successfully reconstructed. However, in some large and complex defects, technically more difficult free flap options may be unavoidable. In our study, we present our experience on upper extremity reconstruction with free flaps. Materials and Methods: Between 2015 and 2021, 9 patients (3 Female, 6 Male) underwent upper extremity reconstructions with free flaps. The ages of the patients ranged from 22 to 68 years. Our free flap choices included anterolateral thigh flap in 4 patients, latissimus dorsi free flap in 4 patients, and radial forearm free flap in 1 patient. Defects of patients were including dorsum of the hand in 3 patients, an amputation stump in 1 patient, the dorsum of the hand with the forearm in 2 patients, and the elbow with the forearm in 3 patients. Results: The radial artery was chosen as the recipient artery in all patients. The concomitant vein of the radial artery or the superficial venous system was used as the recipient vein. End-to-end anastomosis was performed in 6 patients and end-to-side anastomosis was performed in 3 patients. Arterial thrombosis was observed in 1 patient and venous thrombosis was observed in 1 patient. All vascular complications occurred in reconstructions with latissimus dorsi free flaps. Both patients were taken to early salvage surgery, the anastomoses were renewed and the flaps were salvaged. No additional complications were observed in other patients. There was no flap loss in our clinical series. Conclusion: Free flaps can be used safely for upper extremity soft tissue reconstructions in appropriate cases. Although it requires technical experience, we believe that perforator-based free flaps are quite advantageous due to minimal donor site problems and can be safely chosen as the first method in suitable patients.