Free prepuce perforator flap: Ultra-thin superficial penile artery perforator flap for a dorsal finger defect

Dorsal skin defect of the hand/digit requires thin and pliable skin for coverage. The prepuce skin, the second thinnest skin, can be a reconstructive option, but there is no previous report of a free prepuce flap for the reconstruction of the hand/digit. We report the first successful case of a free prepuce flap based on the superficial penile artery perforator (SPAP) for the treatment of dorsal soft tissue defect of the hand/digit. A 68-year-old male presented with a 5 x 3 cm dorsal soft tissue defect of the left index finger with the extensor tendon exposure. A prepuce perforator flap was raised based on the SPAP. The flap was transferred to the recipient site, and the SPAP was supermicrosurgically anastomosed to the dorsal branch of the digital artery. The patient complained no postoperative discomfort of the donor penis, and was satisfied with functionally pleasing and esthetically acceptable results of the reconstructed finger and the donor site. Although only applicable for male patients without past history of penile trauma such as circumcision, a prepuce perforator flap may be an option for thin and pliable skin reconstruction with minimal donor site morbidity. © 2016 Wiley Periodicals, Inc. Microsurgery 37:252-255, 2017.