Arterial or venous free flaps for volar tissue defects of the proximal interphalangeal joint: A comparison of surgical outcomes

Abstract

Background For volar soft tissue defects of the proximal interphalangeal (PIP) joint, free flaps are technically challenging, but have more esthetic and functional advantages than local or distant flaps. In this study, we compared the long-term surgical outcomes of arterial (hypothenar, thenar, or second toe plantar) and venous free flaps for volar defects of the PIP joint.Methods This was a single-center retrospective review of free flap coverage of volar defects between the distal interphalangeal and metacarpophalangeal joint from July 2010 to August 2019. Patients with severe crush injuries (degloving, tendon or bone defects, or comminuted/intra-articular fractures), thumb injuries, multiple-joint and finger injuries, dorsal soft tissue defects, and defects >6 cm in length were excluded from the study, as were those lost to follow-up within 6 months. Thirteen patients received arterial (hypothenar, thenar, or second toe plantar) free flaps and 12 received venous free flaps. Patients’ age, follow-up period, PIP joint active range of motion (ROM), extension lag, grip-strength ratio of the injured to the uninjured hand, and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score were compared between the groups.Results Arterial free flaps showed significantly higher PIP joint active ROM (P=0.043) and lower extension lag (P=0.035) than venous free flaps. The differences in flexion, grip strength, and QuickDASH scores were not statistically significant.Conclusions The surgical outcomes of arterial free flaps were superior to those of venous free flaps for volar defects of the PIP joint.

A dorsalis pedis venous flap containing a U-shaped venous arch for the reconstruction of fingertip defects

“…The flap is easy to dissect, and the harvesting time is only around 15 minutes. Compared with the free perforator flap or free toe flap, venous flaps have less operating time (Choi et al., 2020). Type III venous flaps have a relatively high survival rate and few complications, especially with regard to postoperative atrophy and pigment depositions (Kushima et al., 2002), which were not obvious in our cases.…”

“To and Fro” Blood Flow Mathematical Model in Venous Flap Survival

“…If erythrocyte enters, under the pressure gradient is possible, -erythrocyte departures from capillary in pendulum circulation had no pressure support. Step by step, capillary vessels became blocked and capillary metabolism within the neovascularizated flap was restored after some days [7,8].…”

“…As the result, the diagram (fig. 2) reflects the viable flap width blood pressure depends on factors such as: venous pressure gradient (VP) distal extremities parts maximal flap width (Xmax) 1-2cm; arterial pressure gradient (AP) maximal flap width up to 4-6 см [5,6,7].…”

“…Arterialized venous free flap transplantation is popular in the area of plastic surgery for covering the skin defects [1][2][3][4][5]. However, mechanisms of the survival of the flap is still unclear and the necrosis of the soft tissue after transplantations flap is still possible [6,7].…”