Use of Bilobed Perforator Flaps for Dorsoradial Hand Defects Resulting From Tumor Excision

Dorsal hand defects, often caused by trauma or tumor excision, remain a surgical challenge owing to the complex anatomy and functional demands of the hand. Various methods such as skin grafts, local flaps, and free tissue transfers are available, but each has limitations. The bilobed flap, traditionally used in nasal reconstruction, offers reliable vascularity and favorable aesthetic outcomes; however, its use in dorsal hand defects has rarely been reported.

This retrospective study evaluated 16 patients treated for dorsal hand defects following tumor excision between 2016 and 2021. Reconstruction was performed by using bilobed perforator flaps. Patients with comorbidities, such as diabetes, peripheral vascular disease, vascular sclerosis, or a history of smoking, were excluded. Data collected included patient demographics, defect and flap sizes, complications, postoperative Michigan Hand Outcomes Questionnaire (MHQ) and Vancouver Scar Scale (VSS) scores, and follow-up durations. Flaps were designed based on perforator localization, with primary and secondary lobes proportionally constructed to ensure optimal coverage and minimal tension.

The average age was 55.63 years. Squamous cell carcinoma was the most common type of cancer. The mean defect size was 4.31 cm², and the average follow-up was 16.06 months. Postoperative VSS and MHQ scores indicated satisfactory aesthetic and functional outcomes. Minor complications such as venous congestion and partial necrosis were successfully managed.

Bilobed perforator flaps provide a reliable, functional, and cosmetically favorable option for dorsal hand reconstruction. Their rotational flexibility and minimal donor site morbidity make them a promising alternative for carefully selected patients, expanding their potential utility beyond traditional nasal applications.