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

Junsang Lee; Hyun Sik Park; Bum Suk Oh; Jong Ick Whang; Hyung Gyo Seo

doi:10.12790/ahm.2019.24.4.368

Journal List > Arch Hand Microsurg > v.24(4) > 1143618

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Lee, Park, Oh, Whang, and Seo: Reconstruction of Multiple Fingertip Defects Using the Innervated Radial Artery Superficial Palmar Branch Perforator Flap

Microsurgery

Archives of Hand and Microsurgery 2019; 24(4): 368-375.

Published online: 29 November 2019

DOI: https://doi.org/10.12790/ahm.2019.24.4.368

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

Junsang Lee¹

, Hyun Sik Park², Bum Suk Oh², Jong Ick Whang¹, Hyung Gyo Seo¹

¹Department of Plastic and Reconstructive Surgery, Institute of Hand and Microsurgery, Duson Hospital, Ansan, Korea.

²Department of Orthopedic Surgery, Institute of Hand and Microsurgery, Duson Hospital, Ansan, Korea.

Corresponding author: Junsang Lee. Department of Plastic and Reconstructive Surgery, Institute of Hand and Microsurgery, Duson Hospital, 114 Seonbugwangjang 1-ro, Danwon-gu, Ansan 15368, Korea. TEL: +82-31-402-0114, FAX: +82-31-414-1903, junsang9180@gmail.com

Received 28 May 2019 Revised 23 September 2019 Accepted 26 September 2019

Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Free flap, Finger, Injury

Figures and Tables

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).

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.

Table 1

Summary of cases

M: male, S2PD: static two-point discrimination.

Table 2

Static two-point discrimination

Table 3

Comparison of two groups (S2PD)

S2PD: static two-point discrimination.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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ORCID iDs: Junsang Lee
https://orcid.org/0000-0001-6557-3027
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