Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand

One-stage coverage of multiple or jumping defects in the hand remains a great challenge in reconstructive surgery. A medial sural artery perforator-based conjoined or chimeric flap can be a potential candidate for reconstruction and a versatile donor site for tendon and nerve grafts.

Between September 2009 and December 2012, two free conjoined and three free chimeric medial sural artery perforator flaps were transferred to reconstruct multiple soft tissue defects in the hands. Only patients with more than two perforators in the preoperative Doppler analysis were admitted to this surgical approach. The anatomy, surgical technique, and clinical follow-up for up to 24 months are described.

A variation of two to four perforators was found during dissection. All the flaps survived completely, and one patient developed wound dehiscence, which healed after continuous dressing changes. Two patients received tendon and nerve grafts simultaneously. Three donor sites received an additional free skin graft from the groin region. Follow-up of the five patients ranged from 6 to 24 months (mean 13 months) postoperatively. No obvious donor-site morbidity was observed. The patients were satisfied with the single-stage procedure and the aesthetic outcome of the hands.

The free conjoined or chimeric medial sural artery perforator flap can provide a single-stage solution for multiple defects in the hand. The versatile donor site also provides the option to harvest a segment of a tendon or nerve graft for single-stage composite tissue reconstruction.