Arch Hand Microsurg.  2023 Sep;28(3):174-187. 10.12790/ahm.23.0017.

Finger defect reconstruction using the radial artery superficial palmar branch free flap

• Chi YJ
• Heo JW
• Whang JI
• Park HS
• Yu DH
• Lee J
• Cha JK
• Oh BS

• KMID: 2545528
• DOI: http://doi.org/10.12790/ahm.23.0017

Abstract

Purpose
The radial artery superficial palmar branch (RASP) free flap is accepted as a surgical technique for the reconstruction of finger defects. This study revisited the RASP free flap and evaluated its reliability and usefulness in a variety of finger defects.
Methods
From January 2017 to December 2022, multiple surgeons at a single institution performed a total of 315 RASP free flap reconstructions. Basic patient demographics and information on the finger defect and flap were assessed, and immediate postoperative flap and donor site-related complications were also studied. Data regarding long-term outcomes, such as the thumb joint range of motion and static two-point discrimination (S2PD), were collected and evaluated to identify statistically significant differences from the unaffected or non-innervated side.
Results
The mean postoperative follow-up was 14.8 months. The total flap survival rate was approximately 91.4%. There was no statistically significant difference in mean postoperative palmar abduction and radial abduction between the affected and unaffected thumbs in both groups. In the single-digit group, there was a statistically significant difference in S2PD between the innervated flap and unaffected side. A statistically significant difference was also found between innervated and non-innervated flaps in the multiple-digits group.
Conclusion
The RASP free flap is a valuable surgical option in reconstructing finger defects. It has already been proven to be safe and useful in coverage of single and tip defects. Stability should be ensured when there are multiple defects. Finally, the donor site morbidity is minimal and the recovery of sensation, once the flap is reinnervated, could be promising.

Keyword

Finger; Free flap; Radial artery superficial palmar branch

Figure

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  Fig. 1. (A) Important surface landmarks in elevating the radial artery superficial palmar branch (RASP) free flap. (B) Preoperative color Doppler ultrasonography to identify the origin of the RASP vessel. (C) Schematic diagram of the anatomical landmarks in elevating the RASP free flap. FCR, flexor carpi radialis tendon; MN, median nerve; PL, palmaris longus tendon; Perf., direct skin perforator nearby scaphoid tubercle; RA, radial artery; PL, palmaris longus; PCMN, palmar cutaneous branch of the median nerve.

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  Fig. 2. (A) Flap inset during the reconstruction of multiple digits. Adequate web-space abduction when measuring the flap length and insetting the flap. (B) Large flap with length exceeding 10 cm for reconstructing three or more fingers. (C) Reverse T-shaped radial artery superficial palmar branch free flap

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  Fig. 3. (A) Radial artery superficial palmar branch (RASP) arising from the radial artery and its venae comitantes. (B) Ligation of the efferent ends of the RASP branch and vena comitans. (C) Harvest of the flexor carpi radialis tendon sheath with the flap. (D) Harvest of the palmar cutaneous branch of the median nerve with the flap. Perf., direct skin perforator nearby scaphoid tubercle; FCR, flexor carpi radialis tendon; MN, median nerve; PL, palmaris longus tendon.

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  Fig. 4. Preoperative and postoperative views of z-plasty for flap division in the reconstruction of multiple digits. Note the red lines for z-plasty incision.

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  Fig. 5. (A) Multiple fingertip defects due to traumatic crushing amputations. (B) Harvest of a large 2.0×12.0-cm radial artery superficial palmar branch flap. (C) Inset of the flap into the defect and primary closure of the donor site. (D) One year postoperative.

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  Fig. 6. (A) Left long and ring finger traumatic crushing amputations with a ring finger defect involving both the volar and dorsal sides. (B) Harvest of 2.0×7.0-cm and 2.0×5.0-cm reverse T-shaped radial artery superficial palmar branch flaps. (C) Inset of the flaps into the defect. (D) One year postoperative.

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  Fig. 7. (A) Left index finger soft tissue and bone defect. (B) A 2.0×4.0-cm radial artery superficial palmar branch free flap for soft tissue reconstruction. (C) Preoperative, immediate postoperative, and 1-year postoperative views of the iliac bone strut graft on the distal phalanx bone defect. (D) One year postoperative.

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  Fig. 8. (A) Dermal vein at the proximal end of the radial artery superficial palmar branch (RASP) flap. (B) Elevation of the RASP flap with the vascular pedicled damaged accidentally during flap dissection. (C) Conversion of the RASP free flap into a venous free flap and inset of the flap into the defect. (D) One year postoperative.

Reference

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