Repair of soft tissue defects of the fingers with medial plantar venous flap

Abstract

SUMMARY OBJECTIVE To report the surgical procedures and efficacy of using medial plantar venous flap for the repair of soft tissue defects of the fingers. Methods From March 2010 to April 2012, medial plantar venous flaps were harvested to repair the wounds of 31 fingers in 29 cases. Among them, there were 13 middle fingers with defects at the tips in 11 cases, 7 fingers with defects in the dorsal part in 7 cases, and 11 fingers with defects in the finger pulp in 11 cases. The size of the defects ranged from 1.2cm×1.5 cm to 2.5cm × 3.5cm. Medial plantar venous flaps of 1.5cm × 2cm – 3×4 cm were harvested. Full-thickness skin grafts were adopted for the donor areas. RESULTS All 31 flaps survived, except for 1 flap with arterial crisis and 2 cases with venous crisis. These conditions were timely corrected by secondary anastomosis of artery and vein and the flaps survived. The wounds and the donor areas achieved healing by the first intention. All grafted skins survived. Postoperative follow-up was conducted for 26 fingers in 24 cases for 4-12 months, excluding 5 cases with lost follow-up. The dorsal part of the damaged fingers had normal morphology, and the skin color and texture were similar to those of the normal skin. After the repair of defects in the fingertip and pulp, fingerprints appeared, and the protective sensation was restored. CONCLUSION The soft tissue defects of the fingers can be satisfactorily repaired with medial plantar venous flap, and little damage is caused to the donor area. This method is proven effective for the repair of soft tissue defects of the fingers.

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

“…For this reason every mathematical model is approximate and can't be put into practice. Never the less proposed blood move model based on compressed liquid flow in porous medium have a real experimental and clinical corroboration and confirm the theory of "to and fro" blood circulation flap survival [5,6].…”

“…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].…”

“…As a variant viable flap size may be 5 × 2cm or 3 × 3cm with arterial pressure gradient 30 mm Hg. Venous pressure gradient is not enough to nourish terminal pedicle flape [4,5].…”

“…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].…”