Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction.
Various fingertip reconstructions have been reported for situations where microsurgical finger replantation is impossible. One method is the digital artery perforator (DAP) flap. Herein we report 13 DAP flaps for fingertip and finger stump reconstruction following traumatic finger amputations, highlighting modifications to the originally described DAP flap.


METHODS
From October 1998 to December 2007, a total of 13 fingers (11 patients) underwent fingertip and finger stump reconstruction with modified DAP flaps following traumatic finger amputations. We performed six adipocutaneous flaps, three adipose-only flaps, two supercharged flaps and two extended flaps. Flap size ranged from 1.44 to 8 cm(2) (average 3.25 cm(2)).


RESULTS
All flaps survived completely with the exception of partial skin necrosis in two cases. One of these cases required debridement and skin grafting. Our initial three cases used donor-site skin grafting. The donor site was closed primarily in the 10 subsequent cases. No patients showed postoperative hypersensitivity of repaired fingertips. Semmes-Weinstein (SW) test result for flaps including a digital nerve branch did not differ from those without (average 4.07 vs. 3.92).


CONCLUSIONS
Modified DAP flaps allow for preservation of digital length, volume and finger function. They can be raised as adiposal-only flaps or extended flaps and supercharged through perforator-to-perforator anastomoses. The donor defect on the lateral pulp can be closed primarily or by skin grafting. For traumatic fingertip and finger stump reconstructions, DAP flaps deliver consistent aesthetic and functional results.
Mitsunaga
Narushima
N
Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan. sancho-ps@umin.ac.jp
Mihara
Makoto
M
Koshima
Isao
I
Gonda
Koichi
K
Takuya
Iida
I
Kato
Harunosuke
H
Araki
Jun
J
Yamamoto
Yushuke
Y
Yuhei
Otaki
O
Todokoro
Takeshi
T
Ishikawa
Shoichi
S
Eri
Uehara
U
Mundinger
Gerhard S
GS
D000062:Accidents, Occupational; D000273:Adipose Tissue / Q000098:blood supply / Q000637:transplantation*; D000328:Adult; D000672:Amputation Stumps / Q000601:surgery*; D000673:Amputation, Traumatic / Q000601:surgery*; D001158:Arteries; D062109:Dermatologic Surgical Procedures; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012867:Skin / Q000098:blood supply; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*