The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction

Chi, Zhenglin; Pafitanis, Georgios; Pont, Luis Eduardo Parra; Vijayan, Roshan; Marcelli, Stefano; Gao, Weiyang; Li, Zan; Zhou, Xiao; Song, Dajiang; Yang, Peng

doi:10.1080/2000656x.2017.1360317

Cited by 10 publications

(4 citation statements)

References 15 publications

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“…Hypothenar free flap, venous flap, temporoparietal fascial flap, lateral arm flap, free posterior interosseous flap, toe plantar flap, and innervated radial artery superficial palmar branch flap does the same for fingertip, volar, or degloving defects 5–10 . Although free flaps are technically more demanding, they offer a favorable cosmetic result and acceptable donor site morbidity 25–34 …”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10] Although free flaps are technically more demanding, they offer a favorable cosmetic result and acceptable donor site morbidity. [25][26][27][28][29][30][31][32][33][34] The ALT perforator flap is an excellent material for the development of reconstructing different parts of the body. The ALT has a long-standing heritage as a workhorse-free flap.…”

Section: Discussionmentioning

confidence: 99%

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Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap

et al. 2023

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Background Reconstructing complex soft tissue defects of the finger requires both functional and aesthetic aspects. There are many free tissue transfers as suitable options for digital resurfacing. The anterolateral thigh (ALT) flap is not the first choice for reconstruction of this area because it has the disadvantage that the subcutaneous tissue is too thick; however, its use as a thinned form has yet to be described much. This study presents the flap thinning technique in the small-sized ALT flap for the finger soft tissue defect. Method From May 2009 to March 2018, 10 patients with complete circumferential or semicircumcision defects in the fingers underwent reconstructive procedures that included thinned ALT flap transfer. Finger soft tissue damage due to contusion trauma includes loss of skin and exposure of the bone and tendon. The flap is thinned in 2 different ways: peripheral thinning and total microsurgical thinning, which is selected based on the perforator vessel structure of the flap. Result The ALT flap sizes, averaging 4–9 cm wide and 6–12 cm long, were thinned to 4–7 mm. One perforator was included in the flaps with a pedicle length average of 6.1 cm. The flaps survived entirely in all patients except one with a 30% area in the distal part of the thinned ALT flap that became necrotic because of venous occlusion. Donor sites were closed primarily for all patients. No patients required secondary flap defatting. Conclusions The small thinned ALT perforator flap can be an excellent option for full circumferential or semicircumferential soft tissue defects of the finger. Follow-up showed this as an excellent alternative for finger reconstruction in terms of aesthetic appearance and functional outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap

et al. 2023

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“…The innervated radial thenar flap uses more radial skin to include the superficial sensory nerve of the radial nerve. The SPBRA flap uses a portion of the PCMN, because the SPBRA flap courses transversely along the wrist crease and a nonglabrous skin flap is used [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases

Yang¹

2020

Arch Plast Surg

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Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes.Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated.Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness.Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

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“…The free superficial palmar branch of the radial artery (SPBRA) flap is a workhorse flap used in finger reconstruction. It is advantageous because it is thin, pliable, and has glabrous skin which is similar to that of the fingers (Chi et al, 2018; Yang et al, 2010). Nonetheless, there are no reported cases of covering circumferential defects of the fingertips using a free SPBRA flap.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of circumferential fingertip defect using free superficial palmar branch of the radial artery flap: Report of two cases

Kim,

Lee

2023

Microsurgery

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Wide local excision of noninvasive malignant melanomas has been increasingly performed instead of digit amputation, which often results in extensive fingertip defects. Owing to the unique anatomical characteristics of the fingertips, achieving favorable outcomes in both function and cosmesis is challenging during reconstruction. The free superficial palmar branch of the radial artery (SPBRA) flap is advantageous for finger reconstruction. However, its application in circumferential fingertip defects has rarely been reported. In this report, we describe two cases of circumferential fingertip defect reconstruction using a free SPBRA flap after wide local excision of subungual melanoma. The patients were women aged 74 and 63 years at the time of surgery. They presented with subungual melanoma on the right fourth finger and left thumb, in which both biopsies confirmed malignant melanoma in situ (Tis N0 M0), Breslow thickness of 0 mm (noninvasive). After wide local excision, circumferential defects, sized 2.5 × 6 and 2.7 × 7 cm, were formed on their fingertips. A vertically designed free SPBRA flap measuring 2.7 × 6 and 3 × 6 cm was elevated from the unaffected palm in each patient. After performing microvascular anastomosis, the flap was inserted transversely, wrapping the exposed phalangeal bone in a conical shape. The donor site was primarily closed. All flaps survived, and postoperative complications did not develop. Neither local recurrence nor distant metastasis was detected at the latest follow‐up in either patient at 24 or 28 months postoperatively. The patients were satisfied with the natural contour of the reconstructed fingertip and recovered functions. In the evaluation of subjective sensory recovery using four scales (excellent, good, fair, and poor), they responded “fair” and “good,” respectively. We suggest that the free SPBRA flap could be a reliable reconstructive method for circumferential fingertip defects.

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The use of innervated radial artery superficial palmar branch perforator free flap for complex digital injuries reconstruction

Cited by 10 publications

References 15 publications

Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap

Reconstruction of Finger Soft Tissue Defects With a Thinned Free Anterolateral Thigh Flap

Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases

Reconstruction of circumferential fingertip defect using free superficial palmar branch of the radial artery flap: Report of two cases

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