Clinical Study on Reconstruction of Soft Tissue Defects of the Digits by Volar Flaps

Author(s): Su-Ryon Ryang, Myong-Guk Jang, Kuk-Chol Kim, Song-Gun

Background: Soft tissue deficiency in the upper limb is a common presentation following trauma, burns infection and tumor removal. Soft tissue coverage of the hand is a challenging problem for reconstructive surgeons to manage. The ideal flap for volar defects on the digits should provide glabrous skin, maintain length, and supple enough to allow unimpeded motion of the joints. Local flaps are the common choice in the management of injury. However, the development of microsurgery and clinical practice have greatly boosted the application of different flaps for finger pulp reconstruction with excellent results, especially when local flaps are unsuitable or impossible for the coverage of pulp defects. We newly describe our experience of the use of the transfer of glabrous skins based on the radialis indicis artery and common palmar digital artery for digital (volar) reconstruction.

Methods: Between 2010 and 2014, we used this flaps to reconstruct digital pulp defects in 13 patients with mean age of 33.6 years (range 21-55 years). The dimension of the flaps ranged from 1.8 cm × 2.6 cm to 1.6 cm × 3 .7 cm. The indications for surgery included amputation, severe pulp space infection, crush injury and salvage of failed local flap. The donor site was closed with skin graft directly in all cases.

Results: There were no flap failures. All wounds healed with good functional outcomes with ideal tissue match, minimal donor site morbidity and return of protective sensation despite no neurorrhaphy performed.

Conclusion: Volar flaps has many advantages, approaching ideal replacement for the volar tissues of the fingers, excellent tissue match, minimal donor site morbidity, non-sacrifice of a major vessel, can be made ‘sensory’, neurotises well. We believe that volar flaps is a very reliable and useful option in the armory of the reconstructive hand surgeon.

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