The versatility of the dorsalis pedis compound free flap in hand reconstruction

The dorsalis pedis flap has demonstrated considerable versatility in the reconstruction of composite soft-tissue defects of the hand. It has the potential benefit of being thin and pliable, having reliable vascularity, and being relatively easy to harvest. However, the flap has been plagued by questions of its reliability and concerns over the donor site. An institutional review of dorsalis pedis free flap (DPFF) reconstructions of the hand was performed for the interval 1996-2006. A modified Hallock classification scheme was used to stratify the flaps. A total of 20 DPFF reconstructions of the hand were identified. There were 14 male and 6 female patients aged 20 to 53 years. The ensuing defects included secondary web contracture as well as primary amputations and exposed bony and tendinous structures. The flaps ranged in size from 15 cm2 to 110 cm2. Flap survival was 100% except one partial flap necrosis treated with a secondary skin graft. Partial donor skin graft loss was noted in 5 patients and 3 of them required a secondary resurfacing of the donor site. Functional data on 6 of 7 patients with web space contracture reconstruction showed improvements. DPFF provides durable reconstruction for composite soft-tissue defects of the hand without unduly sacrificing function or form. Donor site complications in our series were minor.