The free neurovascular transverse wrist crease flap for repairing soft tissue defects of the fingers: clinical outcomes of multiple centers

Zhi-Qiang Fan,Bo Cai,Qi Zeng,Sheng-Hui Huang,Guo-Ming Xia,Bao-Fu Yu

doi:10.1186/s13018-019-1444-y

Abstract

BackgroundFlap transplantation is often needed for soft tissue defects of the fingers that cannot be closed directly. Sensory reconstruction of the fingers is important for patients to recover feelings. In this study, we report clinical outcomes of using free neurovascular transverse wrist crease flap for repairing finger defects from multiple centers.MethodsThis case series includes 72 consecutive patients with finger defects between June 2013 and June 2016 from multiple centers. A neurovascular transverse free radial artery superficial palmar branch flap, named transverse wrist crease flap, was designed to reconstruct soft tissue defects of the fingers with microvascular anastomosis. When there were soft tissue defects of the fingers with digital nerve defect, end-to-end neurorrhaphy between the median palmar cutaneous branch and the digital nerves was also performed. The donor incision was sutured directly. All the patients were followed-up for more than 24 months.ResultsThe soft tissue defects of the fingers were all completely covered with this free neurovascular transverse wrist crease flap, and the flaps in 71 patients survived completely without ischemia. Vascular crisis appeared in one case, and the wound healed gradually after changing wound dressing for nearly 1 month. Slight infections of wounds appeared in eight cases. There were no complications in the donor site, like infection and poor wound healing. At the last follow-up, the mean static two-point discrimination was 9.6 ± 2.4 mm on the injured finger and 4.5 ± 0.8 on the contralateral corresponding finger. The motion range of the distal interphalangeal joint and proximal interphalangeal joint on the injured finger were 72.5 ± 23.3% and 78.7 ± 32.5% of the contralateral corresponding finger, respectively. Patient self-evaluations were good in 53 cases and fair in 19 cases.ConclusionsThe results indicate that the free neurovascular transverse wrist crease flap is a good choice for repairing soft tissue defects of the fingers.Level of evidenceTherapeutic IV

Highlights

Flap transplantation is often needed for soft tissue defects of the fingers that cannot be closed directly
We report the clinical outcomes of the free neurovascular transverse wrist crease flap for reconstructing soft tissue defects of the fingers in 72 consecutive patients from multiple centers
Patients A retrospective review was conducted on patients who had soft tissue defects of the fingers and received the transverse wrist crease flap for reconstruction between June 2013 and June 2016 at Jiangxi Provincial People’s Hospital, Jingan Branch of Huashan Hospital attached to Fudan University, Nanchang Shuguang hand and foot surgery Hospital, The First Affiliated Hospital of Nanchang University, The Second Affiliated Hospital of Sun Yat-sen University, and The Seventh Affiliated Hospital of Sun Yat-sen University, China

Summary

Introduction

Flap transplantation is often needed for soft tissue defects of the fingers that cannot be closed directly. We report clinical outcomes of using free neurovascular transverse wrist crease flap for repairing finger defects from multiple centers. There are several kinds of flaps available for covering defects of the fingers, like V–Y advancement flaps, rotation flaps, and cross-finger flaps [3, 4] Each of these techniques has its limitations and cannot be applied to all kinds of finger defects. There are several other studies reporting the clinical effects of this flap for reconstructing finger defects. These studies only include less than 15 cases and reported limited experience of just single hospital. The safety and clinical effects are still needed to be validated with further studies including more patients and centers

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Conclusion