title: Experience in Reconstruction for Small Digital Defects With Free Flaps.
abstract: Traumatic injuries to the digits resulting in soft tissue or bone loss require reconstruction. Traditionally, local flaps, such as homodigital flaps, heterodigital flaps, pedicled flaps, or distant flaps, are used for digital resurfacing. However, free tissue transfers can be used in selected patients. In this study, we present the use of different free flaps including groin skin flaps, groin osteocutaneous flaps, groin chimeric flaps, second dorsal metacarpal artery flaps, and partial toe flaps for digital reconstruction. A total of 19 digits were treated with 16 free flaps in our hospital. Of the flaps used, 5 were free groin skin flaps, 4 were free partial toe flaps, 3 were free groin chimeric flaps, 2 were free groin osteocutaneous flaps, and 2 were free second dorsal metacarpal artery flaps. The average flap size was 4.7 × 2.0 cm (range, 1.5 × 1 to 5 × 4 cm), and the average operative time was 6.0 hours (range, 4-9 hours). All flaps survived without partial or total necrosis. In conclusion, the free flap is a reliable and safe alternative for digital reconstruction. Moreover, the free groin flap provides not only a chimeric pattern for multiple fingers coverage but also an osteocutaneous pattern for thumb lengthening. The free second dorsal metacarpal artery flap provides a tenocutaneous pattern for tendon reconstruction and soft tissue coverage simultaneously, and the free partial toe flap is an excellent alternative for pulp reconstruction in terms of aesthetic appearance and functional outcome.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, Tainan Hospital, Ministry of Health and Welfare; †Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center; ‡Division of Plastic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua; and §Institute of Medicine & School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Min-Hsiang
authors.initials: MH
authors.lastname: Hung
authors.forename: Kuo-Feng
authors.initials: KF
authors.lastname: Huang
authors.forename: Haw-Yen
authors.initials: HY
authors.lastname: Chiu
authors.forename: Wai-Nang
authors.initials: WN
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome