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DOI: 10.1055/s-0035-1549366
Reconstruction of Digital Skin Defects with the Free Wrist Crease Flap
Publikationsverlauf
13. Dezember 2014
28. Februar 2015
Publikationsdatum:
04. Mai 2015 (online)
![](https://www.thieme-connect.de/media/jrm/201506/lookinside/thumbnails/10-1055-s-0035-1549366_140292-1.jpg)
Abstract
Background Soft-tissue digital defects frequently need to be covered by a flap rather than a skin graft. In hand surgery, functional preservation and aesthetic appearance are often as important as procedural efficacy.
Objective We present our clinical experience with reconstruction of digital skin defects with the free wrist crease flap.
Methods From January 2012 to September 2013, 14 digits of 14 patients (10 males, 4 females) were included for evaluation. The procedure was performed with brachial plexus block anesthesia. The superficial palmar branch of the radial artery, a subcutaneous superficial vein, and the palmar cutaneous branch of the median nerve were included in the free wrist crease flap. The flaps were used to reconstruct the skin defect of injured digits through microvascular anastomosis, and donor sites were closed primarily.
Results Postoperative follow-up time ranged from 3 to 25 months. All digital deformities were corrected, all flaps survived completely without ischemia, and none were aesthetically bulky. The area of free wrist crease flaps ranged from 2.5 to 5.0 cm by 2.0 to 3.1 cm. Slight wound infections appeared in two cases. Venous crisis occurred in one case, but it was successfully addressed after vascular exploration and reanastomosis. Sensation determined by static two-point discrimination measured in these flaps 2 months postsurgery was “good” at a mean 9.7 ± 2.1 mm (range, 6–14 mm). The mean motion range of the distal interphalangeal joint and proximal interphalangeal joint was 23.4 ± 6.9 degrees (0–42 degrees) and 75.8 ± 22.1 degrees (0–98 degrees) preoperatively. The mean motion range of the distal interphalangeal joint recovered to 40.3 ± 5.7 degrees (36–42 degrees), and that of the proximal interphalangeal joint was 90.3 ± 15.3 degrees (85–98 degrees) postoperatively. Both joints reached normal motion angle and difference was statistically significant preoperatively and postoperatively (p < 0.05). The mean disabilities of arm and shoulder (DASH) score was 6.8 ± 3.4 (0–15), and there was statistically significant difference when compared with the preoperative score of 13.5 ± 4.3 (3–19) (p < 0.05).
Conclusion We found the free wrist crease flap to be an ideal solution for reconstruction of skin defects of digits.
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References
- 1 Chen C, Tang P, Zhang L. Reconstruction of a soft tissue defect in the finger using the heterodigital neurocutaneous island flap. Injury 2013; 44 (11) 1607-1614
- 2 Chen C, Tang P, Zhang X. Use of the dorsal digital sensate free flap for reconstruction of volar soft tissue defect of digits. Ann Plast Surg 2014; 72 (5) 537-541
- 3 Yan H, Gao W, Zhang F, Li Z, Chen X, Fan C. A comparative study of finger pulp reconstruction using arterialised venous sensate flap and insensate flap from forearm. J Plast Reconstr Aesthet Surg 2012; 65 (9) 1220-1226
- 4 Cho YJ, Roh SY, Kim JS, Lee DC, Yang JW. Second toe plantar free flap for volar tissue defects of the fingers. Arch Plast Surg 2013; 40 (3) 226-231
- 5 Iwuagwu FC, Orkar SK, Siddiqui A. Free superficial palmar branch of the radial artery flap for the reconstruction of defects of the volar surface of the digits, including the pulp. Plast Reconstr Surg 2013; 131 (2) 308e-309e
- 6 Omokawa S, Ryu J, Tang JB, Han J. Vascular and neural anatomy of the thenar area of the hand: its surgical applications. Plast Reconstr Surg 1997; 99 (1) 116-121
- 7 Crosby PM, Dellon AL. Comparison of two-point discrimination testing devices. Microsurgery 1989; 10 (2) 134-137
- 8 Bao QY, Xiao CW, Peng F, Han D, Wang T, Gu YD. Restoration of thumb sensibility with innervated reverse homodigital dorsoradial flap. J Reconstr Microsurg 2014; 30 (1) 15-20
- 9 Feng SM, Gu JX, Liu HJ , et al. Treatment of distal fingertip degloving injuries using a cross-finger flap based on the dorsal branch of the proper digital artery at the middle phalanx. J Reconstr Microsurg 2013; 29 (9) 623-630
- 10 Tsai CC, Lin SD, Lai CS, Chou CK. Reconstruction of the totally degloved little finger with a bilobed digital neurovascular island flap. Ann Plast Surg 1995; 35 (5) 529-533
- 11 Patil RK, Chavre S. Distally based cross-finger flaps for amputation stumps in avulsion amputations. Indian J Plast Surg 2012; 45 (3) 504-511
- 12 Yu G, Lei HY, Guo S, Yu H, Huang JH. Treatment of degloving injury of three fingers with an anterolateral thigh flap. Chin J Traumatol 2011; 14 (2) 126-128
- 13 Yilmaz S, Saydam M, Seven E, Ercocen AR. Paraumbilical perforator-based pedicled abdominal flap for extensive soft-tissue deficiencies of the forearm and hand. Ann Plast Surg 2005; 54 (4) 365-368
- 14 Kawakatsu M, Ishikawa K, Sawabe K. Free arterialised flow-through venous flap with venous anastomosis as the outflow (A-A-V flap) for reconstruction after severe finger injuries. J Plast Surg Hand Surg 2013; 47 (1) 66-69
- 15 De Lorenzi F, van der Hulst RR, den Dunnen WF , et al. Arterialized venous free flaps for soft-tissue reconstruction of digits: a 40-case series. J Reconstr Microsurg 2002; 18 (7) 569-574 , discussion 575–577