Background: A hypothenar perforator free flap, which is harvested from the palm, is suitable for reconstruction of a finger pulp skin defect, but this flap has rarely been reported, and most of these flaps in previous published reports were designed on the proximal zone of the hypothenar area. In the present report, hypothenar perforator free flaps on the distal zone, namely distal hypothenar perforator free flaps, including two sensate flaps, were used for four cases with pulp defects. Methods: Four distal hypothenar perforator free flaps were used for four patients with skin defects of the finger pulp, including one thumb, two index fingers, and one little finger. The average period from the injury to reconstruction was 30.3 days (range 21 to 47 days). The age of the patients ranged from 49 to 68 years, and the flap size ranged from 18 × 30 to 25 × 45 mm2. Two cutaneous branches of the ulnar palmar digital nerve of the little finger were harvested for the sensate flaps. At final follow-up, sensory restoration of the flap was measured using the Semmes-Weinstein monofilament test and the static two-point discrimination test. Results: All donor sites were closed directly, and all flaps survived totally. The average postoperative period was 12 months (range 5 to 15 months). The Semmes-Weinstein monofilament test was all blue (3.61, 3.22, 3.61) for the three flaps followed-up for more than 12 months, including two sensate flaps and one insensate flap. The surgical scars were inconspicuous, and there were no donor site complications. Conclusions: We consider that a distal hypothenar perforator free flap has a high degree of usability for a medium-sized defect such as the whole finger pulp. In the future, whether sensory nerve branches of this flap should be sutured will need to be clarified.

This on-top procedure is useful for improving toe lengthening and bone alignment correction with minimal functional disturbance.

A total of 16 fingers of 16 patients were subjected to fingertip reconstruction using the reverse digital artery island flap (RDAIF). We evaluated the influences of postoperative flap congestion, initial harvested flap size, patient's age and smoking habit on postoperative final flap size and postoperative range of total active motion (TAM) in affected fingers at a mean interval of 11.4 months. In the results, final flap size and TAM showed a tendency to decrease with increase in the initial harvested flap size and age. Eventually, the final flap size moved towards the size of the fingertip defect. Factors of flap congestion and smoking habit had little influence on the change in flap size and TAM. In conclusion, wide harvested flaps showed significant postoperative reduction in size compared with the small flaps, and extensive skin defect after flap harvest caused a decrease in postoperative TAM. Thus, the size of the harvested RDAIF should be comparable to that of the fingertip defect to prevent postoperative decrease in range of motion in affected fingers, and indication of this flap to the elderly needs to be considered.

We report a novel technique: a 1-stage transfer of 2 paddles of thoracodorsal artery perforator (TAP) flap with 1 pair of vascular anastomoses for simultaneous restoration of bilateral facial atrophy. A 47-year-old woman with a severe bilateral lipodystrophy of the face (Barraquer-Simons syndrome) was surgically treated using this procedure. Sufficient blood supply to each of the 2 flaps was confirmed with fluorescent angiography using the red-excited indocyanine green method. A good appearance was obtained, and the patient was satisfied with the result. Our procedure has advantages over conventional methods in that bilateral facial atrophy can be augmented simultaneously with only 1 donor site. Furthermore, our procedure requires only 1 pair of vascular anastomoses and the horizontal branch of the thoracodorsal nerve can be spared. To our knowledge, this procedure has not been reported to date. We consider that 2 paddles of TAP flap are safely elevated if the distal flap is designed on the descending branch, and this technique is useful for the reconstruction of bilateral facial atrophy or deformity.