Reconstruction of Volar Digital Defects: Clinical Experience with the Hipothenar Flap

Abstract

Soft tissue defects of the little finger especially for flexor injuries located on area ll, secondary to traumatic loss or contracture of soft tissue, infection or tumor, are challenging procedures for any hand surgeon. The reconstructive goal is to provide stable coverage to all noble structures exposed. Reconstructive options for this particular area include local, regional and free flaps, but all of them offer an important donor site morbidity. We present tree clinical cases of soft tissue defects of the little finger using the hipothenar fasciocutaneous reversed island flap, designed from the skin located over the abductor digiti minimi, which is on the basis of ulnar palmar digital artery. The donor site was closed primary. Clinical results were satisfactory and donor site wound healing was adequate.

Dorso Proximal Interphalangeal Island Flap

“…This is another advantage of the island flap compared with the approaches used to treat complex lesions. 12,13 Donor-site closure acts as a temporary splint and extends the fingers. Thus, it contributes to flap adaptation at the recipient site.…”

Hypothenar island flap: A safe and excellent choice for little finger defects

“…[ 15 ] The reverse hypothenar flap anatomy has been described earlier, including the number of perforants found and the maximal size of the skin island permitted. [ 1 2 8 9 ] Primary closure of donor site is an advantage compared to many other homodigital flaps. The Allen test is necessary because the ulnar palmar digital vessel is divided at the proximal end and vascularity of the finger entirely depends on the integrity of radial digital vessel.…”

“…stated that venous congestion is a disadvantage of hypothenar island flap. [ 1 ] Hao et al . reported that all the flaps survived without complications.…”

“…The reconstructive needs are to provide stable coverage and sensibility. [ 1 2 ] A functional fifth metacarpus and functional ulnar fingers are important for the locking grip and supporting grip. [ 3 ]…”

“…[ 2 8 ] The number of perforators described in anatomical studies varies from 3 to 6. [ 1 ] A constant sizeable perforator was identified within 0.7 cm from the proximal margin of the A1 pulley. [ 9 ] Neural supply of this area is from the dorsal or palmar cutaneous branches of the ulnar nerve.…”