Use of Distal Hypothenar Perforator Free Flaps for Pulp Defects

Abstract

Background: A hypothenar perforator free flap, which is harvested from the palm, is suitable for reconstruction of a finger pulp skin defect, but this flap has rarely been reported, and most of these flaps in previous published reports were designed on the proximal zone of the hypothenar area. In the present report, hypothenar perforator free flaps on the distal zone, namely distal hypothenar perforator free flaps, including two sensate flaps, were used for four cases with pulp defects. Methods: Four distal hypothenar perforator free flaps were used for four patients with skin defects of the finger pulp, including one thumb, two index fingers, and one little finger. The average period from the injury to reconstruction was 30.3 days (range 21 to 47 days). The age of the patients ranged from 49 to 68 years, and the flap size ranged from 18 × 30 to 25 × 45 mm2. Two cutaneous branches of the ulnar palmar digital nerve of the little finger were harvested for the sensate flaps. At final follow-up, sensory restoration of the flap was measured using the Semmes-Weinstein monofilament test and the static two-point discrimination test. Results: All donor sites were closed directly, and all flaps survived totally. The average postoperative period was 12 months (range 5 to 15 months). The Semmes-Weinstein monofilament test was all blue (3.61, 3.22, 3.61) for the three flaps followed-up for more than 12 months, including two sensate flaps and one insensate flap. The surgical scars were inconspicuous, and there were no donor site complications. Conclusions: We consider that a distal hypothenar perforator free flap has a high degree of usability for a medium-sized defect such as the whole finger pulp. In the future, whether sensory nerve branches of this flap should be sutured will need to be clarified.

The Clinical Effect of Digital Dorsal Fascial Island Flap Combined With Crossfinger Flap for Repairing Distal Degloving Injury and Sensory Reconstruction

“…When suturing the two-leaf tile flap, do not sew under tension, cover the pedicle with oily gauze, and do not press it when bandaging. (6). The patients started active ROM exercises with the help of a physical therapist after 3 weeks.…”

“…Although abdominal pedicled tubular flap can preserve the length of the finger, the finger is edematous and the sensory recovery is poor after surgery. Free toenail flap transplantation is a difficult operation with high risk, great damage to patients, and high requirements for surgeons ( 2 – 6 ).…”

“…Although abdominal pedicled tubular flap can preserve the length of the finger, the finger is edematous and the sensory recovery is poor after surgery. Free toenail flap transplantation is a difficult operation with high risk, great damage to patients, and high requirements for surgeons (2)(3)(4)(5)(6). At present, the digital dorsal fascial island flap has been widely used to repair the soft tissue defect of the dorsal or ventral finger (7)(8)(9)(10).…”

Circumferential resurfacing using the bilateral hypothenar free flaps in a patient with finger squamous cell carcinoma patient: a case report

“…To reconstruct digital phalanx soft tissue defect, there are various options including reverse digital artery island flap, thenar flap, hypothenar free flap, toe pulp flap, and venous free flap [1]. A sensate hypothenar free flap is a good tool to reconstruct skin defects with good sensory recovery [1]. However, the flap size is not sufficient to resurface a circumferentially degloved finger.…”

Quantification of axonal ingrowth and functional recovery in a myocutaneous flap model in rats with strong clinical implications

“…However, clear shortcomings exist in these previous studies with key questions unanswered. In clinical studies, approaches such as two‐point discrimination are commonly adopted for assessment of sensate return with a scarcity of morphological supports due to the intrinsic difficulties of sampling flap tissues from patients 7,8,11,12 . In animal studies, qualitative morphological descriptions without quantification of axonal ingrowth and functional regain are the common approaches adopted 13‐16 .…”