A modification of the Souquet advancement flap in fingertip reconstruction

Abstract

The Hueston local transposition flap and Souquet advancement flap are two commonly employed options in fingertip reconstruction after amputation. Both are rectangular flaps rotated so that the free edge advances to cover the defect in the fingertip. They differ in that the Hueston flap does not include the neurovascular bundle in the free edge, while the Souquet flap does include the bundle. In consequence, the Hueston advances further but is half insensate, while the Souquet advances far less but is sensate. We describe a modification of the Souquet flap that retains the advantages of both flaps while avoiding the drawbacks.

Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries

“…Fibrofatty tissue (only) is sutured under the nail and the skin defect is allowed to heal secondarily. Several types of rotational pulp flaps have been used to cover lateral oblique defects, including the 'Soquet' or 'Hueston' rectangular pulp flaps (Foucher et al, 1994;Lloyd and Sammut, 2013), curved pulp flaps (Ozturk et al, 2016;Tuncali et al, 2006) and triangular pulp flaps (Zhou et al, 2020). Their common features include a need for full flap elevation from the phalanx, flap rotation and finally, the significant size of the distal defective area may remain uncovered and thus be left to heal secondarily.…”

“…The treatment of lateral oblique fingertip defects differs from those of transverse amputations because of their unique anatomical and asymmetrical geometric features. Other flaps for these defects include lateral pulp flaps (Elliot and Jigjinni, 1993), rotational pulp flaps (Lloyd and Sammut, 2013;Ozturk et al, 2016;Zhou et al, 2020), a dorsal transposition flap (Ogunro, 1983), lateral perforator flaps (Shen et al, 2015) and homodigital direct-flow island flaps (Venkataswami and Subramanian, 1980). These flaps are more complex, and some may require skin grafting of the donor site.…”

Volar Neurovascular Advancement Flap With an All Neural Branch–preserving Technique

“…An algorithmic approach to treat a fingertip defect has been established on the basis of several kinds of published surgical options 9. In this article, we postulate a concept of volar advancement flap having similar neurovascular bundle handling of the Hueston and Souquet flap,10 but with 2 free edges. On the basis of the concept, we could design a wide base of volar flap to cover different kinds of defects with reliable perfusion.…”

Primary functional and aesthetic restoration of the fingernail in distal fingertip amputations with the eponychial flap

“…A combined palmar and dorsal tissue loss is common in fingertip injuries, with potentially disabling and aesthetically relevant sequelae. In the last two decades numerous studies have been dedicated to the reconstruction of the palmar aspect of the distal phalanx either by spontaneous healing or various local and distant flaps (e.g., Brown et al, 1999; Lloyd and Sammut, 2012; Qi and Chen, 2012). Most of these techniques provide adequate pulp resurfacing, but associated defects of the nail complex often remain untreated.…”