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J Reconstr Microsurg 2004; 20(5): 367-372
DOI: 10.1055/s-2004-830000
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Free “Kite” Flap: A New Flap for Reconstruction of Small Hand Defects

Michael Pelzer1 , Michael Sauerbier1 , Günter Germann1 , Markus Tränkle1
  • 1Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG, Trauma Center, University of Heidelberg, Germany
Further Information

Publication History

Accepted: 5 March 2004

Publication Date:
06 July 2004 (online)

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Small, thin, and pliable flaps are frequently required in hand surgery to reconstruct defects in functionally important areas such as the pulp or the “contact zones” of the digits. The innervated first metacarpal artery flap (“kite” flap) is a reliable procedure to restore sensibility in the thumb and the digits. Four microsurgical (free) kite flaps to the hand were performed between February, 1993 and August, 1999 in male patients. Follow-up examinations were performed in three patients. The static two-point discrimination in the kite flaps ranged from 8 to 15 mm and did not show any difference compared to flaps from the foot described in the literature. Semmes-Weinstein testing results ranged from normal to protective sensation with a normal sharp vs. dull discrimination. A free kite flap provides a valuable, safe alternative to venous flaps or other free flaps for reconstruction of small defects in the hand

KEYWORDS

Kite flap - pulp - digit

REFERENCES

  • 1 Iwasawa M, Furuta S, Noguchi M et al.. Reconstruction of fingertip deformities of the thumb using a venous flap.  Ann Plast Surg. 1992;  28 187-189
    PubMedGoogle Scholar
  • 2 Lai C S, Lin S D, Yang C C et al.. The adipofascial turn-over flap for complicated dorsal skin defects of the hand and finger.  Br J Plast Surg. 1991;  44 165-169
    CrossrefPubMedGoogle Scholar
  • 3 Lister G. Local flaps to the hand.  Hand Clin. 1985;  1 621-640
    PubMedGoogle Scholar
  • 4 O'Brien B. Neurovascular island pedicle flaps for terminal amputations and digital scars.  Br J Plast Surg. 1968;  21 258-261
    PubMedGoogle Scholar
  • 5 Ozdemir R, Kilinc H, Sensoz O et al.. Innervated dorsal adipofascial turnover flap for fingertip amputations.  Ann Plast Surg. 2001;  46 9-14
    CrossrefPubMedGoogle Scholar
  • 6 Pelissier P, Casoli V, Bakhach J et al.. Reverse dorsal digital and metacarpal flaps: a review of 27 cases.  Plast Reconstr Surg. 1999;  103 159-165
    CrossrefPubMedGoogle Scholar
  • 7 Rose E H. Local arterialized island flap coverage of difficult hand defects preserving donor digit sensibility.  Plast Reconstr Surg. 1983;  72 848-858
    PubMedGoogle Scholar
  • 8 Santa-Comba A, Amarante J, Silva A et al.. Reverse dorsal metacarpal osteocutaneous flap.  Br J Plast Surg. 1997;  50 555-558
    CrossrefPubMedGoogle Scholar
  • 9 Adani R, Cardon L J, Castagnetti C et al.. Distal thumb reconstruction using a mini wrap-around flap from the great toe.  J Hand Surg. 1999;  24B 437-442
    PubMedGoogle Scholar
  • 10 Buncke H J, Rose E H. Free toe-to-fingertip neurovascular flaps.  Plast Reconstr Surg. 1979;  63 607-612
    CrossrefPubMedGoogle Scholar
  • 11 Buncke H J, Buncke G M. Free pulp transfer. In Foucher G Fingertip and Nailbed Injuries. New York; Churchill Livingston 1991: 92-97
    Google Scholar
  • 12 Eadie P A, Jenner D A, Sakai K. Clinical experience with the second metatarsal artery neurovascular flap.  Br J Plast Surg. 1992;  45 136-140
    CrossrefPubMedGoogle Scholar
  • 13 May Jr J W, Chait L A, Cohen B E et al.. Free neurovascular flap from the first web of the foot in hand reconstruction.  J Hand Surg. 1997;  2A 387-393
    PubMedGoogle Scholar
  • 14 Morrison W A, O'Brien B M, MacLeod A M et al.. Neurovascular free flaps from the foot for innervation of the hand.  J Hand Surg. 1978;  3A 235-242
    PubMedGoogle Scholar
  • 15 Morrison W A. Thumb and fingertip reconstruction by composite microvascular tissue from the toes.  Hand Clin. 1992;  8 537-550
    PubMedGoogle Scholar
  • 16 Strauch B, Tsur H. Restoration of sensation to the hand by a free neurovascular flap from the first web space of the foot.  Plast Reconstr Surg. 1978;  62 361-367
    PubMedGoogle Scholar
  • 17 Wei F C, Chen H C, Chuang D C et al.. Second toe wrap-around flap.  Plast Reconstr Surg. 1991;  88 837-843
    CrossrefPubMedGoogle Scholar
  • 18 Takeuchi M, Sakurai H, Sasaki K et al.. Treatment of finger avulsion injuries with innervated arterialized venous flaps.  Plast Reconstr Surg. 2000;  106 881-885
    CrossrefPubMedGoogle Scholar
  • 19 Tsai T M, Matiko J D, Breidenbach W et al.. Venous flaps in digital revascularization and replantation.  J Reconstr Microsurg. 1987;  3 113-119
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Hilgenfeldt O. Operativer Daumenersatz. Stuttgart; Enke Verlag 1950
    Google Scholar
  • 21 Foucher G, Braun J B. A new island flap transfer from the dorsum of the index to the thumb.  Plast Reconstr Surg. 1979;  63 344-349
    CrossrefPubMedGoogle Scholar
  • 22 Traenkle M, Sauerbier M, Heitmann C, Germann G. Restoration of thumb sensibility with the first metacarpal artery island flap.  J Hand Surg. 2003;  28 758-766
    PubMedGoogle Scholar
  • 23 Germann G, Raff T, Schepler H et al.. Salvage of an avascular thumb by arteriovenous flow reversal and a microvascular ‘kite’ flap: case report.  J Reconstr Microsurg. 1997;  13 291-295
    PubMedGoogle Scholar
  • 24 Germann G, Shermann R, Levin L S. Decision-Making in Reconstructive Surgery: Upper Extremity. New York, Berlin; Springer 2000: 192-193
    Google Scholar
  • 25 Earley M J. The arterial supply of the thumb, first web and index finger and its surgical application.  J Hand Surg. 1986;  11B 163-174
    PubMedGoogle Scholar
  • 26 Earley M J, Milner R H. Dorsal metacarpal flaps.  Br J Plast Surg. 1987;  40 333-341
    CrossrefPubMedGoogle Scholar
  • 27 Earley M J. The second dorsal metacarpal artery neurovascular island flap.  J Hand Surg. 1989;  14B 434-440
    PubMedGoogle Scholar
  • 28 Endo T, Kojima T, Hirase Y. Vascular anatomy of the finger dorsum and a new idea for coverage of the finger pulp defect that restores sensation.  J Hand Surg. 1992;  17A 927-932
    PubMedGoogle Scholar
  • 29 Jing H, Liu X Y, Ge B F et al.. The second dorsal metacarpal flap with vascular pedicle composed of the second dorsal metacarpal artery and the dorsal carpal branch of radial artery.  Plast Reconstr Surg. 1993;  92 501-506
    CrossrefPubMedGoogle Scholar
  • 30 Littler J W. The neurovascular pedicle method of digital transposition for reconstruction of the thumb.  Plast Reconstr Surg. 1953;  12 303-319
    CrossrefPubMedGoogle Scholar
  • 31 Chiu H Y, Shieh S J, Hsu H Y. Multivariate analysis of factors influencing the functional recovery after finger replantation or revascularization.  Microsurgery. 1995;  16 713-717
    PubMedGoogle Scholar
  • 32 Dellon A L. Sensory recovery in replanted digits and transplanted toes: a review.  J Reconstr.Microsurg. 1986;  2 123-129
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Omokawa S, Mizumoto S, Iwai M et al.. Innervated radial thenar flap for sensory reconstruction of fingers.  J Hand Surg. 1996;  21A 373-380
    PubMedGoogle Scholar
  • 34 Allan C H. Functional results of primary nerve repair.  Hand Clin. 2000;  16 67-72
    PubMedGoogle Scholar
  • 35 Vertruyen M F, Burgeon M A, Dachy B S et al.. Sensory recovery after microsurgical repair of digital nerves.  Acta Chir Bleg. 1994;  94 325-328
    PubMedGoogle Scholar
  • 36 Eisenschenk A, Lehnert M. Sensory recovery after finger replantation [in German].  Handchir Mikrochir Plast Chir. 1993;  25 191-195
    PubMedGoogle Scholar
  • 37 Beam et al.. Presented at the The 2001 Inaugural Congress of the World Society for Reconstructive Microsurgery November 2, 2001 Taipei, Taiwan;

Michael PelzerM.D. 

Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG, Trauma Center, University of Heidelberg

Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany

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