Free Digital Artery Flap

Abstract

The heterodigital arterialized flap is increasingly accepted as a flap of choice for reconstruction of large finger wounds. However, in situations where the adjacent fingers sustained concomitant injuries, the use of this flap as a local flap is precluded. This paper describes our experience with the free digital artery flap as an evolution of the heterodigital arterialized flap. Four patients with large finger wounds were reconstructed with free digital artery flap. Our indications for digital artery free flap were concomitant injuries to adjacent fingers that precluded their use as donor sites. The arterial supply of the flap was from the digital artery and the venous drainage was from the dominant dorsal vein of the finger. The flap was harvested from the ulnar side of the finger. The digital nerve was left in situ to minimize donor morbidity. The donor site was covered with a full-thickness skin graft and secured with bolster dressings. Early intensive mobilization was implemented for all patients. All flaps survived. No venous congestion was noted and primary healing was achieved in all flaps. In addition to providing well-vascularized tissue for coverage of vital structures, the digital artery was also used as a flow-through flap for finger revascularization in one patient. Donor-site morbidity was minimal, with all fingers retaining protective pulp sensation and the distal and proximal interphalangeal joints retaining full ranges of motion. In conclusion, the free digital artery flap is a versatile flap that is ideal for coverage of large-sized finger defects in situations where local flaps are unavailable. Donor-site morbidity can be minimized by preservation of the digital nerve, firmly securing the skin graft with bolster dressings, and early mobilization of the donor finger.

Venous Flow-Through Flap Reconstruction Following Severe Finger Wound Infection: Case Report

“…4,5 Traditional skin flaps such as skin advancement flaps may be insufficient to cover larger defects in the digit. 6 Cross-finger flaps and thenar flaps have been used to cover such wounds; however, they are often complicated by digital stiffness and pigmentation disparities of the donor sites. 7,8 In the case of severe wound infection to the digit, the flow-through flap offers a reconstructive alternative to these options as it provides sufficient tissue and is readily vascularized, and the donor site is often well preserved.…”

Utilizing Free Skin Grafts in the Repair of Surgical Wounds

“…Pedicle flaps [1,2] were then developed in order to enhance graft survival using sequential revascularization techniques. These are difficult to perform, and involve the anastomoses of arteries and veins, and transfer of deep tissues such as the gracilis muscle, latissimus dorsi muscle, and bone [1][2][3][4][5][6][7][8]. They are also are frequently multi-staged [1,2], although single-staged free pedicle flaps from neighboring tissue have been described [3,4].…”