Reconstruction of fingertip with hypothenar free perforator flaps

Abstract

Introduction: In fingertip injuries where replantation is not possible, options for reconstructing the fingertip with similar type of tissue are limited. Palmar and plantar regions are the donor sites that offer similar characteristics. In this study, we aim to evaluate the clinical outcomes of the hypothenar perforator free flap from the palmar region, compare this flap with the reports available in the literature, and share our experience regarding the practicality of the flap. Patients and Methods: The two-center retrospective clinical study included 15 patients who were operated on between 1 June 2015 and 31 December 2017. All patients were analyzed according to their demographic characteristics, mode and level of injury. Perforator flaps used in fingertip reconstruction were analyzed for skin island size, number of anastomosed arteries and veins, and number of reconstructed nerves. Static and dynamic two-point discrimination tests were applied, and grip strength and pulp-to-pulp pinch measurements were performed in the 13th-month visit of each patient. Surgical results were assessed with the Michigan Hand Outcomes Questionnaire (MHQ). Results: Mean age of the 15 patients was 39.1 years (range: 27-61). While majority of the injuries were of crush type, 8 cases were classified as Ishikawa subzone 2 and 3 cases as Ishikawa subzone 1. One perforator artery and 2 veins were anastomosed in 13 cases. Neural reconstruction was performed in all of the cases. Mean dynamic two-point discrimination value was 3.0 mm (range: 2.8-3.2). Mean grip strength was 42.5 kg (range: 17.7-74.8) and mean pulp-to-pulp pinch strength was 10.7 kg (range: 5-19). MHQ results were 90% in subgroup 1, 95.3% in subgroup 2, 79.5% in subgroup 3, 92.9% in subgroup 5, and 93% in subgroup 6. Conclusion: In cases of fingertip injuries where replantation is not possible, hypothenar free perforator flaps come forth as a sophisticated reconstruction option with favorable outcomes suitable to the similar tissue principle.