A dorsalis pedis venous flap containing a U-shaped venous arch for the reconstruction of fingertip defects

Abstract

In small-area soft tissue defects of the fingers, venous flaps have the advantages of easy design and harvesting, and also a thin and flexible texture. Although the artery–vein–vein (A–V–V) pattern is the safest pattern, the tiny veins in the finger pulp make anastomosis difficult. We have designed a modified blood flow pattern flap using the dorsum of the foot as the donor site and anastomosing the U-shaped blood vessels in the venous flap with the two digital arteries in an artery–vein–artery (A–V–A) pattern to reconstruct the digital arterial arch without the need for venous anastomosis. Our study included 22 patients with 23 fingertip defects. In the 23 fingers, 18 flaps survived completely and four had only partial marginal necrosis. The donor site healed well without significant scar hyperplasia. Level of evidence: IV

Comparison treatment of medium-sized volar fingertips defects with modified triangular neurovascular unilateral advancement flap versus digital artery dorsal perforator flap

“…Typically, there is agreement that replantation is the optimal treatment for fingertip loss restoration. However, several reconstructive flaps have been described with varying outcomes in cases where replantation is not feasible [ 16 ]. These methods include secondary intention healing, Kutler and Atastoy V–Y advancement flap, triangular neurovascular advancement flap, cross-finger flap, retrograde flow digital artery flap, and free toe tissue transfer [ 6 – 9 , 17 ].…”

“…Healing by secondary intention is an effective treatment for individuals with no exposed phalanx and tendons. Nevertheless, it poses a significant risk of phalangeal osteomyelitis and tendon necrosis, and it results in significant scar formation [ 16 ]. This scar can limit the motion and sensory function that is essential for the final function of the finger.…”

Vascularized lymph node flaps can survive on venous blood without an arterial inflow: an experimental model describing the dynamics of venous flow using indocyanine green angiography (With video)

“…described the classification of venous flaps in more detail [ 22 ]. Although the exact blood flow pattern of the venous flap was not adequately investigated, clinical practice showed that the venous flap could survive and work; therefore, it can be used as an alternative procedure in case of an unreliable arterial blood supply of the flap [ 23 ].…”