Free Flap From the Superficial Palmar Branch of the Radial Artery (SPBRA Flap) for Finger Reconstruction

Abstract

Functional reconstruction after a severe hand injury is best achieved by obtaining primary, stable soft tissue coverage to avoid delayed wound healing, prolonged immobilization, and joint stiffness. A wide range of procedures from spontaneous healing to local flaps has been proposed to treat soft tissue defects in appropriate circumstances. However, these pedicled flaps are insufficient in covering larger finger defects, so we used flaps from the free superficial palmar branch of the radial artery (SPBRA) for such cases. Between June 2003 and May 2007, 11 people with traumatic finger injury were treated with SPBRA flaps. The blood supply of the flap is derived from the SPBRA, which can be palpated and confirmed by Doppler flowmetry 18 mm proximal to the palmar wrist crease. Anastomoses of vessels were performed under a microscope, linking the SPBRA to the digital artery and the concomitant vein to the digital dorsal vein. The defects were located at the fingertip in seven patients, in the dorsum of the proximal phalanx in two, and at the interphalangeal joint in two. The average flap size was 8.4 cm with the largest flap being 12.5 cm2 (50 mm x 25 mm). All the flaps survived completely and the wound healed satisfactorily, except for one partial necrosis. All the donor sites were closed primarily without complications or obvious scarring. Most of the fingers involved achieved a full range of motion and showed a good contour. Two-point spatial sensory discrimination was recorded for six patients and adequate protective sensation was attained. The SPBRA flap provides a thin, pliable, reliable, and good glabrous skin flap for covering medium to large finger defects. Only one operative field is required and the major vessels are preserved. This approach can add to the armamentarium of the plastic surgeon for covering large defects of the finger.