Extended applications of distally based axial adipofascial flaps for hand and digits defects

Reverse axial adipofascial flaps use subcutaneous tissue of the laterodigital and dorsal metacarpal or digital areas. They are sited on the arterial branches anastomosing the volar and dorsal arterial networks of the fingers. These flaps allow coverage of wide and distal defects. Metacarpal flaps were used for defects on the proximal phalanx, and digital flaps for the defects over the proximal interphalangeal joint (PIPj) and further distally of the thumb and fingers. A series of 18 cases is reviewed. Dissection of the flap is easy, fast and preserves the collateral nerve and artery of the finger. Skin defects were combined with bone, joint or tendon exposure. The flaps we used were reliable, and bone, joint and tendon reconstruction could be performed at the same time. Procedures were performed in an outpatient setting. Patients were allowed to mobilise the hand as early as possible. The results showed partial distal necrosis in one case and partial loss of the overlying skin graft in two cases, who resolved spontaneously. Donor-site morbidity was minimal.