Arch Hand Microsurg.  2019 Dec;24(4):368-375. 10.12790/ahm.2019.24.4.368.

Reconstruction of Multiple Fingertip Defects Using the Innervated Radial Artery Superficial Palmar Branch Perforator Flap

• Lee J
• Park HS
• Oh BS
• Whang JI
• Seo HG

• KMID: 2464473
• DOI: http://doi.org/10.12790/ahm.2019.24.4.368

Abstract

PURPOSE
The reconstruction of posttraumatic fingertip defects requires adequate soft tissue coverage, sensibility and minimal donor site morbidity. Reconstruction is more difficult in the case of multiple fingertip defects. The purpose of this study was to report the results of reconstruction of multiple fingertip defects using the innervated radial artery superficial palmar branch perforator flap (iRASP).
METHODS
We performed 19 cases of the iRASP for the reconstruction of multiple fingertip defects. The surgery was performed in two stages. In the first stage, defects were covered with the iRASP. In the second stage, the flap was divided 2-3 weeks after the first operation.
RESULTS
All flaps survived. At the last follow-up, static two-point discrimination was measured. A mean of 7.6 mm (6-9 mm) was measured on the affected side and 3.6 mm (2-5 mm) on the contralateral side. The sensory examination was performed at a mean 6.8 months (4-11 months) after surgery. Postoperatively, some patients complained of pain in the donor scars, but most of them disappeared after six months. Debulking surgery was not needed to improve the contours.
CONCLUSION
We reconstructed multiple fingertip defects using the iRASP, and obtained satisfactory functional and cosmetic results. Four fingertip defects could be reconstructed with one flap and with satisfactory sensory recovery. Therefore, the iRASP is considered an appropriate treatment for reconstruction of multiple fingertip defects.

Keyword

Free flap; Finger; Injury

MeSH Terms

Cicatrix
Discrimination (Psychology)
Fingers
Follow-Up Studies
Free Tissue Flaps
Humans
Perforator Flap*
Radial Artery*
Tissue Donors

Figure

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  Fig. 1 (A) A 43-year-old male with a skin defect of the left 3rd, and 4th fingers caused by a crushing injury. (B) Flap design. (C) Flap insetting. (D) Postoperative photo, six months after surgery (informed consent was taken).

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  Fig. 2 (A) A 30-year-old male with skin defect of the left 2nd, 3rd, 4th and 5th fingers caused by a crushing injury. (B) Flap elevation size 10.5 cm×3.0 cm. (C) Flap insetting. (D) Postoperative photo, three months after surgery.

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