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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(06): 745-749
DOI: 10.1055/a-1938-0691
Hand/Peripheral Nerve
Original Article

Reconstruction of Multiple Digital Defects by Temporary Syndactylization Using a Lateral Arm Free Flap

Sae Hwi Ki 
1   Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, People's Republic of Korea
2   Department of Plastic and Reconstructive Surgery, School of Medicine, Inha University, Incheon, People's Republic of Korea
,
Jin Myung Yoon 
1   Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, People's Republic of Korea
,
Tae Jun Park 
1   Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, People's Republic of Korea
,
M. Seung Suk Choi 
3   Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, South Korea
,
Min Ki Hong 
1   Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, People's Republic of Korea
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Abstract

Background Soft tissue defects of the multiple finger present challenges to reconstruction surgeons. Here, we introduce the use of a lateral arm free flap and syndactylization for the coverage of multiple finger soft tissue defects.

Methods This retrospective study was conducted based on reviews of the medical records of 13 patients with multiple soft tissue defects of fingers (n = 33) that underwent temporary syndactylization with a microvascular lateral arm flap for temporary syndactylization from January 2010 to December 2020. Surgical and functional outcomes, times of flap division, complications, and demographic data were analyzed.

Results Middle fingers were most frequently affected, followed by ring and index fingers. Mean patient age was 43.58 years. The 13 patients had suffered 10 traumas, 2 thermal burns, and 1 scar contracture. Release of temporary syndactyly was performed 3 to 9 weeks after syndactylization. All flaps survived, but partial necrosis occurred in one patient, who required a local transposition flap after syndactylization release. The mean follow-up was 15.8 months.

Conclusion Coverage of multiple finger defects by temporary syndactylization using a free lateral arm flap with subsequent division offers an alternative treatment option.

Keywords

soft tissue defects - multiple defects - traumatic injury - amputation - free flap

Availability of Data and Materials

Data were obtained from medical records, in strict accordance with the privacy policy and ethical code of our institute.


Ethical Approval and Consent to Participate

The study involved standard treatment regimens and approved by the Institutional Review Board (IRB NO. 2022–03–040). All procedures were performed after obtaining informed consent from all patients. The study was performed in accordance with the Declaration of Helsinki.


Patient Consent

Patients provided written informed consent for the publication and the use of their images.


Authors' Contributions

Sae Hwi Ki conceptualized the study. Tae Jun Park and Jin Myung Yoon were involved in data curation. Tae Jun Park and Jin Myung Yoon contributed to investigation. Sae Hwi Ki supervised the study. Sae Hwi Ki and Choi MSS were involved in writing—original draft. Choi MSS and Min Ki hong contributed to writing—review and editing.


Financial Support and Sponsorship

None.




Publication History

Received: 14 April 2022

Accepted: 22 July 2022

Accepted Manuscript online:
07 September 2022

Article published online:
13 December 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Paterson P, Titley OG, Nancarrow JD. Donor finger morbidity in cross-finger flaps. Injury 2000; 31 (04) 215-218
    CrossrefPubMedGoogle Scholar
  • 2 Han SK, Lee BI, Kim WK. The reverse digital artery island flap: clinical experience in 120 fingers. Plast Reconstr Surg 1998; 101 (04) 1006-1011 , discussion 1012–1013
    CrossrefPubMedGoogle Scholar
  • 3 Arsalan-Werner A, Brui N, Mehling I, Schlageter M, Sauerbier M. Long-term outcome of fingertip reconstruction with the homodigital neurovascular island flap. Arch Orthop Trauma Surg 2019; 139 (08) 1171-1178
    CrossrefPubMedGoogle Scholar
  • 4 Gregory H, Heitmann C, Germann G. The evolution and refinements of the distally based dorsal metacarpal artery (DMCA) flaps. J Plast Reconstr Aesthet Surg 2007; 60 (07) 731-739
    CrossrefPubMedGoogle Scholar
  • 5 Vuppalapati G, Oberlin C, Balakrishnan G. “Distally based dorsal hand flaps”: clinical experience, cadaveric studies and an update. Br J Plast Surg 2004; 57 (07) 653-667
    CrossrefPubMedGoogle Scholar
  • 6 Woo SH, Kim KC, Lee GJ. et al. A retrospective analysis of 154 arterialized venous flaps for hand reconstruction: an 11-year experience. Plast Reconstr Surg 2007; 119 (06) 1823-1838
    CrossrefPubMedGoogle Scholar
  • 7 Lee DC, Kim JS, Ki SH, Roh SY, Yang JW, Chung KC. Partial second toe pulp free flap for fingertip reconstruction. Plast Reconstr Surg 2008; 121 (03) 899-907
    CrossrefPubMedGoogle Scholar
  • 8 Al-Qattan MM, Al-Qattan AM. Defining the indications of pedicled groin and abdominal flaps in hand reconstruction in the current microsurgery era. J Hand Surg Am 2016; 41 (09) 917-927
    CrossrefPubMedGoogle Scholar
  • 9 Adani R, Tarallo L, Marcoccio I, Cipriani R, Gelati C, Innocenti M. Hand reconstruction using the thin anterolateral thigh flap. Plast Reconstr Surg 2005; 116 (02) 467-473 , discussion 474–477
    CrossrefPubMedGoogle Scholar
  • 10 Kim SW, Lee HJ, Kim JT, Kim YH. Multiple-digit resurfacing using a thin latissimus dorsi perforator flap. J Plast Reconstr Aesthet Surg 2014; 67 (01) 74-80
    CrossrefPubMedGoogle Scholar
  • 11 Sérane-Fresnel J, Lafosse T, Amsallem L, Chaves C, Delpit X, Chassat R, Masméjean EH. Fingertip reconstruction by palmar bipedicular island flap in long fingers (modified neurovascular Tranquilli-Leali flap): A dual-center study. Hand Surg Rehabil 2020; Feb; 39 (01) 59-64
    CrossrefPubMedGoogle Scholar
  • 12 Atasoy E, Ioakimidis E, Kasdan ML, Kutz JE, Kleinert HE. Reconstruction of the amputated finger tip with a triangular volar flap. A new surgical procedure. J Bone Joint Surg Am 1970; 52 (05) 921-926
    CrossrefPubMedGoogle Scholar
  • 13 Katz RD. The anterograde homodigital neurovascular island flap. J Hand Surg Am 2013; 38 (06) 1226-1233
    CrossrefPubMedGoogle Scholar
  • 14 Evans DM, Martin DL. Step-advancement island flap for fingertip reconstruction. Br J Plast Surg 1988; 41 (02) 105-111
    CrossrefPubMedGoogle Scholar
  • 15 Ki SH. Lateral arm free flap with preservation of the posterior antebrachial cutaneous nerve. Ann Plast Surg 2016; 76 (05) 517-520
    CrossrefPubMedGoogle Scholar
  • 16 Ulusal BG, Lin YT, Ulusal AE, Lin CH. Free lateral arm flap for 1-stage reconstruction of soft tissue and composite defects of the hand: a retrospective analysis of 118 cases. Ann Plast Surg 2007; 58 (02) 173-178
    CrossrefPubMedGoogle Scholar
  • 17 Hage JJ, Woerdeman LA, Smeulders MJ. The truly distal lateral arm flap: rationale and risk factors of a microsurgical workhorse in 30 patients. Ann Plast Surg 2005; 54 (02) 153-159
    CrossrefPubMedGoogle Scholar
  • 18 Hennerbichler A, Etzer C, Gruber S, Brenner E, Papp C, Gaber O. Lateral arm flap: analysis of its anatomy and modification using a vascularized fragment of the distal humerus. Clin Anat 2003; 16 (03) 204-214
    CrossrefPubMedGoogle Scholar