Reconstruction of Digital Skin Defects with the Free Wrist Crease Flap.
BACKGROUND
Soft-tissue digital defects frequently need to be covered by a flap rather than a skin graft. In hand surgery, functional preservation and aesthetic appearance are often as important as procedural efficacy.


OBJECTIVE
We present our clinical experience with reconstruction of digital skin defects with the free wrist crease flap.


METHODS
From January 2012 to September 2013, 14 digits of 14 patients (10 males, 4 females) were included for evaluation. The procedure was performed with brachial plexus block anesthesia. The superficial palmar branch of the radial artery, a subcutaneous superficial vein, and the palmar cutaneous branch of the median nerve were included in the free wrist crease flap. The flaps were used to reconstruct the skin defect of injured digits through microvascular anastomosis, and donor sites were closed primarily.


RESULTS
Postoperative follow-up time ranged from 3 to 25 months. All digital deformities were corrected, all flaps survived completely without ischemia, and none were aesthetically bulky. The area of free wrist crease flaps ranged from 2.5 to 5.0 cm by 2.0 to 3.1 cm. Slight wound infections appeared in two cases. Venous crisis occurred in one case, but it was successfully addressed after vascular exploration and reanastomosis. Sensation determined by static two-point discrimination measured in these flaps 2 months postsurgery was "good" at a mean 9.7 ± 2.1 mm (range, 6-14 mm). The mean motion range of the distal interphalangeal joint and proximal interphalangeal joint was 23.4 ± 6.9 degrees (0-42 degrees) and 75.8 ± 22.1 degrees (0-98 degrees) preoperatively. The mean motion range of the distal interphalangeal joint recovered to 40.3 ± 5.7 degrees (36-42 degrees), and that of the proximal interphalangeal joint was 90.3 ± 15.3 degrees (85-98 degrees) postoperatively. Both joints reached normal motion angle and difference was statistically significant preoperatively and postoperatively (p < 0.05). The mean disabilities of arm and shoulder (DASH) score was 6.8 ± 3.4 (0-15), and there was statistically significant difference when compared with the preoperative score of 13.5 ± 4.3 (3-19) (p < 0.05).


CONCLUSIONS
We found the free wrist crease flap to be an ideal solution for reconstruction of skin defects of digits.
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Gan-lin
GL
Zhang
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Hong
H
Meng
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Jian-Hua
JH
Huang
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Xiao-Fang
XF
Hong
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Hua-Sheng
HS
Zhang
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Xiao-Tao
XT
Liu
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
He-Yuan
HY
Luo
Department of Plastic and Traumatic Surgery, HuiZhou Affiliated Hospital, Sun Yat-sen University (HuiZhou Municipal Central Hospital), HuiZhou, China.
Wei-Yong
WY
Liu
D000293:Adolescent; D000328:Adult; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005384:Finger Joint / Q000502:physiology; D006225:Hand / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D061525:Perforator Flap; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult