Free mini-flaps in finger’s soft-tissues defects recontruction

Abstract

Introduction. Reconstruction of fingers with skin and soft tissue defects remains challenging. Optimal reconstructive treatment should be simple, reliable, cost effective, and provide pliable, sensitive, and cosmetically similar tissue that will allow adequate function. A free flap of appropriate size may provide ideal surgical solution, since is associated with shorter time of returning to work and satisfactory function and aesthetic appearance. Aim of the study. To compare outcomes of fingers’reconstruction using free arterialized venous flap (AVF), superficial palmar branch of radial artery flap (SUPBRA), dorsal radial perforator flap (DRAP), and dorsal ulnar perforator flap (DUAP) harvested from ipsilateral extremity. Materials and methods. During 6 months were performed 4 types of free flaps from the ipsilateral extremity in reconstruction of finger’s defects, with small/moderate skin defects, including: 1 AVF, 3 SUPBRAs, 1 DRAP, and 1 DUAP. Standardized assessment of outcomes was performed, including duration of operation, objective sensory recovery, cold intolerance, time of returning to work, active total range of motion (ROM) of injured fingers, and cosmetic appearance of donor/recipient sites. Results. All flaps survived completely, follow-up duration was 12months. Mean duration of complete surgical procedure for AVFs was distinctly shorter than for others. SUPBPRA was used to reconstruct skin and extensor tendon defects using vascularized palmaris longus graft in 1 case. Optimal sensory recovery was better in AVFs and SUPBRAs as compared in DUAPs and DRAPs. No significant differences were noted in ROM or cold intolerance between 4 types. Optimal cosmetic satisfaction was noted for recipient sites of AVFs and donor sites of SUPBRAs. Conclusions. All 4 types of free flaps are a practical choice in finger reconstruction for small/moderate-sized skin defects. SUBPRAs play an important role due to wider indications, better sensory recovery and cosmetic appearance associated with this method.