Coverage of the dorsal surface of a digit based on a pedicled free-style perforator flap concept.

Background: Reconstruction of the finger and thumb dorsum has been considered difficult because of the need for a thin and flexible flap, and the surrounding tissue is sometimes insufficient for a local flap. The purpose of this report is to describe our concept for finger and thumb dorsum reconstruction with free-style perforator flaps and our clinical experience with transfer of various perforator flaps.
Methods: Thirty-two finger dorsum defects in 32 patients were covered with pedicled free-style perforator flaps. The perforator origin was a digital artery perforator in 22 cases and a dorsal metacarpal artery perforator in 10 cases. The flap style was advancement type in 11 cases, rotation in 2, propeller in 14, and adipofascial in 5.
Results: The mean size of the digital artery perforator flap was 3.4 cm ² and that of the dorsal metacarpal artery perforator flap was 7.9 cm ² . All flaps, except for two propeller flaps with 180 degrees rotation, survived completely. These flaps were of elongated style, and the length-to-width ratios were approximately 3:1 and 3.5:1, respectively.
Conclusions: There are multiple perforators in the finger and thumb dorsum region from the proper digital artery, which are suitable for pedicled free-style perforator flaps. These perforators increase flap flexibility and reliability in clinical applications.
(Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)