J Korean Soc Surg Hand.  2017 Mar;22(1):63-67. 10.12790/jkssh.2017.22.1.63.

Reconstruction of the Hand Using Fabricated Great Toe Pulp and Anterolateral Thigh Chimeric Free Flap

• Do SB
• Kim JH
• Chung CH

• KMID: 2375469
• DOI: http://doi.org/10.12790/jkssh.2017.22.1.63

Abstract

In the treatment of large hand soft tissue defect including pulp defect, it has been recommended to reconstruct pulp defect separately by glabrous skin flap such as toe pulp free flap or thenar free flap considering of skin texture, color and sensation. But sometimes we may not use recipient digital artery which is required for microanastomosis because of the injury of digital artery. To solve this problem, the authors reconstructed thumb pulp and hand palmar area soft tissue defect with fabricated flow-through chimeric free flap connecting distal part of descending branch of lateral circumflex femoral artery which distributes perforators of anterolateral thigh free flap and pedicle of great toe pulp free flap and met with good results.

Keyword

Toe pulp free flap; Anterolateral thigh free flap; Soft tissue defect

MeSH Terms

Arteries
Femoral Artery
Free Tissue Flaps*
Hand*
Sensation
Skin
Thigh*
Thumb
Toes*

Figure

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  Fig. 1 Preoperative photograph shows extensive soft tissue defect and necrotic tissue of thumb pulp and hand palmar area.

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  Fig. 2 Intraoperative photograph. (A) Exposed flexor tendons, digital artery and nerve and distal phalanx of thumb after debridement of necrotic tissue. (B) Elevated anterolateral thigh free flap with proximal and distal part of descending branch of lateral circumflex femoral artery forming T-shaped pedicle. (C) Elevated great toe pulp free flap including dorsal the first dorsal metatarsal artery and dorsal metatarsal veins.

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  Fig. 3 Postoperative photograph shows soft tissue defect covered with fabricated great toe pulp and anterolateral thigh chimeric free flap.

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  Fig. 4 Postoperative photograph shows range of pinching action.

Reference

1. Gu JX, Pan JB, Liu HJ, et al. Aesthetic and sensory reconstruction of finger pulp defects using free toe flaps. Aesthetic Plast Surg. 2014; 38:156–163.

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3. Kim HH, Woo SH, Seul JH. Reconstruction of soft tissue hand defects using various skin free flaps from the foot. J Korean Soc Surg Hand. 1998; 3:237–248.

4. Kim KC, Sun SH, Kim HS, Kim SE, Chung CE, Rhyou IH. The versatility of the anterolateral thigh perforator flap for reconstruction of soft tissue defect of the upper extremity. J Korean Soc Surg Hand. 2007; 12:56–63.

5. Park SH, Kim HS, Kim SE. Reconstruction of the digit using anterolateral thigh perforator flap. J Korean Soc Surg Hand. 2012; 17:183–190.