Repair of soft tissue defects at middle or distal part of 2nd~ 5th finger and donor site with relaying reversed perforator flaps

Abstract

Objective To investigate the clinical effectiveness of the reversed flaps pedicled with lateral vascu-lar chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery for relaying repair of soft tissue defects at middle-distal part of the 2nd~ 5th finger and donor site. Methods From June, 2014 to May, 2016, a total of 18 cases (11 male and 7 female) with soft tissue defects at middle-distal part of 2nd~ 5th finger were treated with the reversed flap pedicled with lateral vascular chain of dorsal branch of digital artery. The donor site was re-paired with the reversed flap pedicled with the perforating branch of the dorsal metacarpal artery. The average age at the time of reconstruction was 41 years. The right hand was involved in 12 cases and the left in 6 cases. The etiologies of in-jury were avulsion (n=5) , crush (n=6) , and saw-cut injury (n=7) . There were 15 cases with soft tissue defect at the distal phalanx and 3 cases with loss of distal and middle phalanx. All these cases were exposed with bone or tendon. The defect size ranged from 1.0 cm × 1.8 cm to 2.0 cm × 3.0 cm. And the dimension of the reversed flaps pedicled with later-al vascular chain of dorsal branch of digital artery and perforating branch of the dorsal metacarpal artery ranged from 1.2 cm × 2.0 cm to 2.3 cm × 3.3 cm, and 1.4 cm × 2.3 cm to 2.6 cm × 3.6 cm, respectively. Postoperative follow-up was done termly. Results All flaps survived uneventfully with primary healing at donor site. The mean of followed-up time was 11 months (ranged from 6 to 15 months) . The appearance and texture of the flaps were satisfactory and similar to the surrounding tissue. There was only some linear scar left at the dorsum of the palm. On the basis of the MHQ, 16 pa-tients were strongly satisfied (score 5) with the appearance of the flap, and the remaining 2 patients was satisfied (score 4) with the appearance. The static 2-point discrimination of the flaps at the middle-distal part of 2nd~5th finger was 5-9 mm. Based on TAM assessment, the function of the injured finger was graded as excellent in 15 cases, good in 3 cases. Conclusion The relaying reversed flaps pedicled with lateral vascular chain of dorsal branch of digital artery and per-forating branch of the dorsal metacarpal artery can be applied for repair of soft tissue defects at middle-distal part of 2nd ~ 5th finger and donor site with easy procedure, reliable blood supply, satisfactory results, good appearance as well as less complications at donor sites. Key words: Perforator flaps; Finger injuries; Soft tissue defects; Microsurgical operation