Abstract
BackgroundThe treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.MethodsThis retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.ResultsAfter more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference between postoperative complications and 2-PD test result in patients without nerve injury. And in terms of overall function, Modified VSS score and 2-PD test (the patients with nerve injury), There were relatively obvious statistical differences, MPAF was superior to DDMF (p < 0.005).ConclusionMPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.
Highlights
The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear
There were no significant differences between the groups in the terms of age, sex, etiology, nerve injury, or site and size of the defect
One patient in the dorsal digital–metacarpal flap (DDMF) group had a complication of hyperplastic scar contracture that decreased the range of motion; it improved with rehabilitation
Summary
The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. Soft-tissue defects on the volar surface of the finger are highly common and frequently accompanied by exposed tendons, digital nerves and vessels, flap reconstruction is often necessary [1]. Following the first description of the dorsal metacarpal artery by Holevich [7], Foucher and Brauna improved the technique and designed a sensate island flap raised on the first dorsal metacarpal artery flap with its concomitant veins and a sensory branch of the superficial radial nerve in 1979 [8]. Oberlin et al [10] demonstrated that it provided stable, pliable, durable, innervated, glabrous, and non-hairy skin This is a relatively ideal supply area to the palmar area. With significant advances in microsurgery, it is not technically challenging to design free flaps based on the medial plantar artery
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