Double-pivot proper digital artery perforator flap for fingertip reconstruction

Area of Science:

• Plastic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Traditional dorsal flaps for fingertip reconstruction using proper digital artery perforators face challenges due to small vessel diameter and length, increasing risks of pedicle kinking or occlusion.
• This study introduces a modified approach to address these limitations in fingertip pulp defect repair.

Purpose of the Study:

• To present preliminary results of a novel double-pivot perforator flap technique for fingertip reconstruction.
• To evaluate the efficacy and safety of this modified flap in repairing finger pulp defects.

Main Methods:

• A double-pivot flap was designed based on the end-dorsal perforator branch of the proper digital artery, originating from the dorsal middle phalanx.
• The flap design included the perforator and a segment of the artery trunk, creating a pedicle with increased diameter and length.
• Twelve patients with fingertip soft-tissue defects underwent this procedure in a retrospective study.

Main Results:

• All flaps demonstrated successful survival without necrosis.
• Three patients experienced transient venous flow issues that resolved spontaneously.
• At a mean follow-up of 20 months, the average static two-point discrimination was 7.0 mm.

Conclusions:

• The double-pivot proper digital artery flap is a dependable option for fingertip reconstruction.
• This technique provides improved rotational flexibility and a reduced risk of vascular compromise.
• The procedure facilitates satisfactory recovery of cutaneous sensation in the reconstructed fingertip.