Reconstruction of Skin Defects on Multiple Fingers with a Free Bridging Venous Flap-Case Report

Abstract

Background: Skin defects on multiple digits with joint or tendon exposure is a challenging problem which necessitates simultaneous coverage with a well vascularized tissue. Aim and Objectives: We report a case with skin defects on two fingers reconstructed with a single ”bridging” venous flap. Materials and Methods: A twenty-year-old female came to our clinic for crush and contact burn injury to her left index and middle fingers. After removal of the necrotic skin, a skin defect was noted on the dorsal side of the index finger from the middle phalanx to the nail matrix with exposure of the lateral bands, and the middle finger had a skin defect at the distal phalanx with exposure of the distal interphalangeal joint (DIP joint). A ”snow-man” like free venous flap was harvested from her left forearm to cover the skin defects. One domain of the flap was used to cover the defect on the middle finger and the other domain was used to cover the defect on the index finger, which created temporary syndactyly. Three weeks later the flap was divided. Results: The left hand has a good function at a 13-month follow-up. Conclusion: A single ”bridging” venous flap can be used to reconstruct multiple skin defects on multiple digits simultaneously. The ”bridging” venous flap provides a thin and reliable coverage of the defects and spares the surgeon from a multiple-staged abdominal flap or a long operation of multiple free flaps to cover multiple skin defects.