Syndactylizing arterialized venous flaps for multiple finger injuries

Abstract

Multiple soft tissue finger defects in different shapes and locations are usually difficult to manage. Such defects commonly involve tendons and bones. Palmar soft tissue defects may also lead to vascular compromise. In this retrospective report, we report the results of seven patients with multiple soft tissue finger defects that were covered by syndactylizing arterialized venous flaps. Six of the patients suffered hot-pressing machine and crushing injuries, one patient had a rolling belt injury. All patients presented with soft tissue defects on palmar or dorsal sides involving at least two digits. The palmar forearm was donor site for all patients. At least one afferent artery and two efferent veins were selected for the anastomosis. Lengths of afferent and efferent veins were long enough to perform healthy anastomosis outside the injury zone. The afferent vessels were anastamosed to the digital arteries with the largest possible diameter or to the common digital arteries to maximize flow. The efferent veins were anastamosed to dorsal veins. Separations of the digits were performed after three weeks by longitudinal incisions. The mean follow-up period was 12 months. None of our patients suffered a flap loss. Syndactylizing arterialized venous flaps may be used for composite or single tissue reconstruction for multiple finger defects with satisfactory cosmetic and functional outcomes.

Sensate superficial inferior epigastric artery flap innervated by the iliohypogastric nerve for reconstruction of a finger soft tissue defect

“…Therefore, we decided to reconstruct with a flap. There are many other flaps for reconstruction of this case including local/distant flaps and free flaps such as medial plantar flap, medialis pedis flap, and venous flap, that we offered as reconstructive options before the treatment . Because the patient desired a concealable donor site with less morbidity, we decided to use a flap from the lower‐abdominal/inguinal region.…”

“…There are many other flaps for reconstruction of this case including local/distant flaps and free flaps such as medial plantar flap, medialis pedis flap, and venous flap, that we offered as reconstructive options before the treatment. [10][11][12] Because the patient desired a concealable donor site with less morbidity, we decided to use a flap from the lower-abdominal/inguinal region. SCIP flap and SIEA flap have a long pedicle suitable for various reconstructions, and their donor scars are well-concealable.…”

Using an unconventional perfusion pattern in ear replantation-arterialization of the venous system

“…33 Utilization of arterialized venous flaps is progressively gaining popularity in microsurgical reconstruction, with applications in hand surgery being most common. 34,35 Flap survival of greater than 90% has been reported and techniques have been developed, that is, retrograde arterialization, to mitigate the so-called short circuit effect. 34 Increased clinical experience with these vehicles has, thus, resulted in expansion of clinical indications for their use.…”

Syndactylized glabrous flaps for multiple finger palmar defects

“…Free arm flaps can be used to cover all types of finger defects (Ki et al, 2022). Free venous flaps in a syndactylizing fashion can also be used to cover defects (Kayalar et al, 2014). None of these flaps accurately provide the glabrous needs of the fingers.…”

“…And digital artery island flaps from the adjacent finger may not be used because that finger is also injured. In such situations, syndactylizing free or pedicled flaps can be used (Kayalar et al, 2014; Trovato et al, 2008; Wang et al, 2018). Most syndactylizing flaps involve non‐glabrous flaps.…”