The Glabrous Palmar Flap

Abstract

We devised a new flap using the palmar cutaneous branch of the superficial radial artery proximally and anastomosed with a cutaneous perforator of the superficial palmar arch distally. We named our flap "the volar glabrous palmar flap." The flap was used both as a free flap and as a reverse-flow island flap. Thirty-six patients with volar hand defects (24 digits, 7 palms, and 5 first web space) were reconstructed with this flap. The flap was used as a proximally based free flap in 15 patients and was used as a reverse-flow island flap based on distal communication in the remaining 21 patients. Free flaps were supplied by the palmar branch of the superficial radial artery and its fasciocutaneous extensions; reverse-flow island flaps were supplied by one of the perforating branches of the superficial palmar arch, which is connected to the proximal fasciocutaneous branches. Flaps extended from the wrist crease to the proximal palmar crease and were designed medially on the thenar crease, extending 2 to 2.5 cm laterally. Flap sizes ranged from 1.5 x 2.2 cm to 2.5 x 10 cm. The palmar cutaneous branch of the median nerve within the flap area was identified and then was sutured to the divided digital nerve in 6 cases of finger pulp defect. The donor sites were closed and repaired primarily in most cases. The postoperative course was uneventful, and all the flaps survived without major complications. Follow-up (minimum 6 mo, mean 24 mo) showed excellent functional and cosmetic results. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer for pulp defects. At the same time, we studied 6 cadaver hands to understand the vascular anatomy of the thenar area of the hand. We also revised several published anatomic papers to obtain a refined and scrutinized understanding of the palmar anatomy.

The free neurovascular transverse wrist crease flap for repairing soft tissue defects of the fingers: clinical outcomes of multiple centers

“…For experienced surgeons, it usually takes approximately 30 min for harvesting RASPB flap and another 1 h for anastomosis of digital artery, superficial vein, and digital nerve. Therefore, we can usually complete all the procedure within 2 h. Previously, there are have been several studies reporting the clinical effects of this flap for reconstructing finger defects [5–7]. But these studies only include less than 15 cases and reported limited experience of just a single hospital.…”

“…The RASPB usually divides from the radial artery at 1.0–2.0 cm proximal to the distal wrist crease [6], with mean diameter at its original site being 1.2 mm (range, 1.0–1.4 mm), which is similar to the diameter of the digital artery [7]. The RASPB then descends along the ulnar side of scaphoid tubercle [8] and commonly goes together with one or two venae comitantes [9].…”

Reverse Superficial Palmar branch of Radial artery pedicled flap for Palmar and Digital reconstruction: A systematic review of literature with a retrospective case review

“… Reference Sample Size Immediate Complications Late complications Follow-up (months) Outcome Sensory recovery (2PD) Omokawa et al 6 1996 1 None None 10 No data 8mm Omokawa et al 7 2002 6 Distal necrosis (1) - healed spontaneously None 61 Acceptable cosmetic result of donor site 6,4,6mm in innervated flaps. Orbay et al 8 2009 21 Distal necrosis - (1) in 76M, Dupuytrens, healed spontaneously. None 24 Excellent cosmetic and functional 6mm for 1 case Seyhan T 9 2009 7 Distal necrosis (1) in a 70-year old.…”

Treatment of unfavourable results of flexor tendon surgery: Skin deficiencies

“…Most of the older generation of free flaps, although avoiding the second stage, take longer to perform, have the same problem of subcutaneous fat and will swell significantly, so, require secondary thinning of the flap later. The newer generation of free flaps includes some, such as the instep fla[1011] [Figure 10] and the newer version of free venous flap[12–14] [Figure 11] and the glabrous palmar flap[15] which have little subcutaneous fat, largely, but not entirely, avoid this problem. The venous flaps return again to the flexor aspect of the wrist as a donor site for thin skin.…”