Free Medial Plantar Artery Perforator (MPAP) Flap for the Resurfacing of Finger Defect-Report of Two Cases

Abstract

Background: Finger destruction secondary to trauma represents a much more significant influence on the activity of daily living. Various surgical techniques contribute to cover the distal defect of the finger. Aim and Objectives: We would like to introduce a find-designed perforator skin flap to reconstruct the finger defects. Material and Method: Two patients received free medial plantar artery perforator (MPAP) flaps to resurface the palmar defects of fingers. The flaps were harvested without interrupting the circulation of the medial plantar artery. The flap perforator was anastomosed to proper digital artery and the superficial vein of the MPAP flap was anastomosed to dermal vein of the injured finger which had no severe length discrepancy or metacarpophalangeal joint injury. Results: One male and one female patient were arranged for free MPAP flap reconstruction in March and August 2007. The mobility of the fingers was not restricted after surgery. One flap survived completely with no vascular compromise. Another flap encountered venous congestion and only partially failed (30% loss) after salvage. Conclusion: The MPAP flap is a suitable choice to reconstruct defect of the finger with less donor site morbidity. The cushiony characteristic of the MPAP flap is anatomically similar to the pulp tissue of fingers. Technical difficulty is focused on anastomosis of perforators (diameter≦ 0.8mm) and limited access of concomitant vein. With the many advantages of the MPAP flap, it is worthy of application to more reconstruction needs, particularly for finger defects.