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Related Experiment Videos

Microvascular soft tissue reconstruction of the digits.

A Turner1, R Ragowannsi, J Hanna

  • 1Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital, Holyte Road, East Grinstead, West Sussex RH19 3DZ, UK. ajturner@doctors.org.uk

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|April 25, 2006
PubMed
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Small free flaps offer a viable solution for digital reconstruction after trauma, with venous flow-through flaps yielding the best outcomes. However, first web space donor sites present significant scarring issues.

Area of Science:

  • Plastic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Traumatic composite tissue loss in digits often necessitates flap coverage.
  • Local reconstruction techniques can lead to donor site functional deficits.
  • Small free flaps present a complex yet potentially superior alternative for digital reconstruction.

Observation:

  • A retrospective review of 18 digital free flaps in 16 trauma patients (2000-2004) was conducted.
  • Follow-up included 10 patients (11 flaps) assessing scar quality, sensation, range of motion, and hand function.
  • Flap types included venous flow-through, lateral arm, great toe, first web space, medial plantar, and posterior interosseous flaps.

Findings:

  • 16 out of 18 flaps survived with an average follow-up of 14 months.

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  • Most patients achieved excellent hand function (quick-DASH avg. 5.7), satisfactory aesthetics, and minimal pain.
  • Flaps were soft and durable; 10 recovered protective sensation. First web space donor sites resulted in significant hypertrophic scarring.

    • Implications:

    • Small free flaps are an acceptable reconstructive method for digital defects.
    • Venous flow-through flaps demonstrated the most favorable results in this series.
    • First web space donor sites are considered suboptimal due to scarring concerns.