Finger pulp reconstruction with free flaps from the upper extremity

Abstract

Although never exceeding a few square centimeters, finger pulp defects are reconstructive challenges due to their special requirements and lack of neighboring tissue reserve. Local flaps are the common choice in the management of this injury. However, the development of microsurgery and clinical practice have greatly boosted the application of different free flaps for finger pulp reconstruction with excellent results, especially when local flaps are unsuitable or impossible for the coverage of large pulp defects. These flaps are all located in the same operation field and can be performed under one tourniquet; therefore, they are more convenient with better patients' compliance in clinical setting. Nonetheless, there is still no consensus about which type of these flaps should be preferred among various finger pulp reconstructive options. In this article, we attempt to review articles describing finger pulp reconstruction using free flaps from the upper extremity from the literature. We summarize the clinical applications of these free flaps and detail their advantages and drawbacks, respectively. The algorithm of flap selection for finger pulp reconstruction based on our experience and literature review is also discussed. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

The posterolateral mid‐forearm perforator flap: Anatomical study and clinical application

“…The perforator consistently present at the posterolateral aspect of the mid‐forearm has already most recently been described by the Gao et al who identified four patterns of the perforator: pattern I arising posterior interosseous artery, pattern II arising from the interossous recurrent artery, pattern III arising from the common interosseous artery, pattern IV arising from a large descending branch of the radial recurrent artery. Patterns I, II, and III arose from the interosseous artery system, accounting for 80.4%, and pattern IV arose from the radial recurrent artery, accounting for 19.6%.…”

Effects of preserving different veins on flow-through flap survival: An experimental study

“…Application of venous flow-through flaps in the reconstruction of soft tissue defects has been widely used, which can involve flow-through flaps as a vessel carrier or arterialized venous flaps (23,24). The difference between venous flow-through flaps and conventional flaps is that arterial inflow-capillary-venous outflow is replaced by venous inflow-venous outflow (25).…”

Use of non-enhanced angiography to assist the second toetip flap transfer for reconstruction of the fingertip defect

“…Fingertip defect can be treated with various methods such as local flaps and free flaps. For finger pulp defect without bony or nail defect, various local/free flaps and toe flaps can offer functionally and esthetically pleasing results . When the distal phalanx and the nail matrix were lost, toetip flap with a part of the toe distal phalanx and the toe nail allows the possible best reconstruction with minimal donor site morbidity .…”