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In this report we present a case of large sized volar surface defect of a digit reconstructed by hypothenar perforator free flap coverage. A 57-year-old male patient presented with a 5 × 2 cm sized avulsive injury on his left little finger involving near total loss of the volar surface. The perforator arteries of the hypothenar area were identified around 5-15% on the x-axis and 25-50% on the y-axis (y-axis: a line from the pisiform base to the metacarpophalangeal joint, x-axis: a line perpendicular to the y-axis.) The hypothenar free flap was designed centered on the anticipated location of the perforator artery. Upon dissection, the perforator artery was found as predicted and a superficial palmar vein was saved for venous drainage. In addition, a neighboring cutaneous branch of the ulnar nerve was also saved. The flap survived with satisfactory flap contour, durability, skin color and texture. Five months of follow-up showed acceptable range of motion for joints of the affected digit and nearly full range of motion for the hand. The sensate hypothenar perforator free flap could be considered as a useful surgical option for large sized volar side defects of finger.

Although skin- or nipple-sparing mastectomy has been popular in the treatment of breast cancer, the radical excision of breast tissue is unavoidable in certain circumstances. However, the ability of an acellular dermal matrix (ADM) to expand remains questionable, and this situation may further hinder tissue expansion. From October 2017 to January 2020, patients who underwent immediate breast reconstruction with tissue expander placement using ADM whose initial fill volume was less than 50 mL were retrospectively reviewed. The primary outcomes were the number of visits and number of days required to complete the expansion, and the secondary outcomes were the amount of postoperative expansions, expander fill ratio and expander volume. Between the prepectoral group (n = 26) and subpectoral group (n = 39), the mean number of days (81.46 days versus 88.64 days, p = 0.365) and mean number of visits (5.08 versus 5.69, p = 0.91) required to complete expansion exhibited no significant differences. Additionally, there were no significant differences in the mean amount of postoperative expansion (314.23 mL versus 315.38 mL, p = 0.950), the mean final volume (353.08 mL versus 339.62 mL, p = 0.481) or the mean final volume ratio (0.89 versus 0.86, p = 0.35) between the two groups. Therefore, we suggest that prepectoral tissue expander placement after conventional mastectomy can be a valid option.

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