Use of the Dorsal Digital Sensate Free Flap for Reconstruction of Volar Soft Tissue Defect of Digits

Abstract

Sensate cross-finger flaps and homodigital and heterodigital island flaps can usually be used for sensory reconstruction in the volar aspect of the digit. However, when the donor areas are damaged by concomitant injuries, these flaps are not available. The free dorsal digital flap, including both dorsal branches of the proper digital nerves, can be used as an alternative to resolve this problem. The flap was used in 16 patients with soft tissue defects on the volar aspect of the digits. For comparison, we collected a consecutive series of 31 patients with similar defects treated using a cross-finger flap including one branch. At final follow-up, the static 2PD of 2-branch flap is superior to 1-branch flap. The dorsal digital sensate free flap can be used as an alternative for the reconstruction of volar soft tissue defect of the digits. Sufficient sensory recovery can be achieved using this technique.

Bilaterally innervated dorsal digital flap for sensory reconstruction of digits

“…When the homodigital and heterodigital sensate flaps are not feasible because of concomitant injuries to donor fingers, the bilaterally innervated free flap should be considered. This free flap is only an additional option for the sensory reconstruction of digits due to the need for microsurgery and the risk of anastomosis failure [24].…”

Treatment of fingertip defect with reversed digital artery island flap through superficial vein anastomosis

“…In recent years, free flaps for fingertip defect repair have been favoured by experts 7,19 . According to our unpublished data, the surgical time for free flaps has increased by nearly 2 h compared with this operation, making it difficult to popularize for emergency treatment.…”

“…In recent years, free flaps for fingertip defect repair have been favoured by experts. 7,19 According to our unpublished data, the surgical time for free flaps has increased by nearly 2 h compared with this operation, making it difficult to popularize for emergency treatment. Therefore, we strongly believe that an anastomotic venous RDAIF is the preferred method for repairing fingertip defects with bone or tendon exposure.…”

“…Furthermore, long‐term immobilization after the operation can cause joint stiffness. With the development of microsurgery, a skin toenail flap 6 or free flap 7 can also reconstruct fingertips perfectly, but the technical requirements of hand surgeons are high, rendering this procedure difficult to promote in primary hospitals.…”

Reconstruction of Digital Skin Defects with the Free Wrist Crease Flap

“…It is often difficult to cover distal defects of the digit because there is very little soft tissue available in this particular region. Consequently, while various flaps have been used, including rotation flaps, V-Y advancement flaps, and cross-finger flaps, [1][2][3] each of these incurs its own limitations and no individual technique is applicable to all types of digital pulp injuries. In addition, these flaps can only be applied to cover small defects, require a skin graft, and/or are considerably invasive.…”