Surgical Refinements and Sensory Recovery of Using Transverse Sensate Thoracodorsal Artery Perforator Flaps to Resurface Ring-Avulsed Fingers

Abstract

To improve the use of thoracodorsal artery perforator flaps in resurfacing ring-avulsed fingers, the relations between the thoracodorsal artery perforators and intercostal nerves were investigated. The surgical refinements, clinical results, and sensory recovery of flaps were presented. Eleven patients with ring-avulsed fingers were reviewed. Separated and conjoint relations were found. Eleven flaps were harvested with 3 refinements. First is the transverse flap design. Second is operating color Doppler sonography to identify the relations. Third is using the conjoint relation to facilitate adequate flap thinning. Four patients had separated relation, and 7 patients had conjoint relation. Only 1 patient showed flap tip necrosis. Two patients with separated relation needed flap debulking. Ten patients acquired protective to normal tactile sensation, and 9 patients gained fair to normal discriminative sensation. The free transverse sensate thoracodorsal artery perforator flaps can be an option in the reconstruction of ring-avulsed fingers.

Comparison of spontaneous sensory recovery of noninnervated anteromedial thigh flap, latissimus dorsi flap, and gracilis muscle flap in lower extremity reconstruction: A prospective comparative study

“…The sensory recovery of the reconstructed lower extremities becomes an important issue, because a protective sensibility is imperative in preventing unintentional injuries resulting from pressure sores or burns. Although sensory recovery was extensively studied in various fields such as autologous breast reconstruction (Beugels et al, ; Santanelli, Longo, Angelini, Laporta, & Paolini, ), mammoplasty (Chiari Jr., Nunes, Grotting, Cotta, & Gomes, ), digital repair (Bulut et al, ; Lin & Chen, ), burn scars (Meirte et al, ), oral reconstruction (Boyd et al, ; Kimata et al, ), and lower lip reconstruction,(Ayhan Oral et al, ) only little is known about this issue in free flap extremity reconstruction. In addition, the reported studies were performed with different sensory test modalities and examination times, thereby making comparison invalid.…”

Comparison of Thigh-Based versus Groin-Based versus Lateral-Thoracic-Based Flaps for Hand Resurfacing: A Review Article

“…There has been a paradigm shift in reconstructive surgery to avoid multiple-stages whilst attaining good coverage, functionality i.e. protective sensation and good range of movement, aesthetics and minimizing donor site morbidity 3 . Classically, resurfacing would involve multi stage-surgery with reconstruction and subsequent flap thinning 4 .…”

“…Unlike the pedicled groin-flap early wrist physiotherapy can be started. However, like the groin flap it is bulky requiring subsequent flap thinning 3 . Tare et al present the free 'mini' groin-flap, based on the SCIA, to resurface dorsal and circumferential defects of the digits and palmar defects 2 .…”

“…Finger defects can be resurfaced with thoracodorsal artery perforator-flaps based on septo-cutaneous perforators from the thoracodorsal artery 3 . Advantages include its large hairless skin paddle and long pedicle of 10 cm with a diameter of 1mm with minimal donor site morbidity.…”

“…Disadvantages include a technically challenging flap harvest with complex variability in nervous supply posing challenges and long harvests of a sensate flap 24 . Subsequent essential thinning of the flap, containing a separated perforator and nerve, can damage intercostal nerves and therefore a conjoint relation between perforator and nerve is favored 3 . If a conjoint relationship is not identified then flap thinning is required in a second stage with sensory risks.…”