Extending the reach of the heterodigital arterialized flap by vein division and repair.
The heterodigital arterialized flap is ideal for nonsensory reconstruction of sizable soft-tissue defects in the proximal fingers, web spaces, and the hand. The inclusion of a dorsal vein augments the venous drainage of this digital island flap and avoids the problem of postoperative venous congestion, which is a common problem in digital island flaps. However, the presence of a dorsal vein pedicle inhibits flap mobility somewhat, and the reach of the flap is mainly limited to adjacent fingers. In situations that demand a transfer from a nonadjacent donor finger or when the reach from the adjacent donor finger is inadequate, the dorsal vein pedicle can be temporarily divided and then anastomosed microsurgically after flap transfer is performed. This enables the reach of the flap to be extended up to two fingers from the donor finger. The authors performed this "partially free" heterodigital arterialized flap in 11 consecutive patients between 1991 and 2001. The average size of the defects was 4.4 x 2.3 cm. All of the flaps survived completely, without any evidence of postoperative flap congestion. Healing of all of the flaps was primary and did not result in any scarring. All of the donor fingers had "normal" two-point discrimination of 3 to 5 mm. All of the donor fingers retained excellent or good total active motion, as graded by the criteria of Strickland and Glogovac.
Tay
Shian-Chao
SC
Department of Hand Surgery, Singapore General Hospital, Singapore. tay_sc77@yahoo.com
Teoh
Lam-Chuan
LC
Tan
Soo-Heong
SH
Yong
Fok-Chuan
FC
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D002057:Burns, Chemical / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000209:etiology / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D007239:Infections / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012092:Replantation; D012189:Retrospective Studies; D016038:Skin Transplantation; D013524:Surgical Flaps / Q000098:blood supply*; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery