gms | German Medical Science

Objectives/Interrogation: We report our method of flap transfer to repair the defect of fingers using the proper digital artery and volar digital veins.

Methods: From December 2014 to April 2018, we used free flaps to 12 fingers (11 patients) with soft tissue defect in fingers using the proper digital artery and volar digital veins as the recipient vessels. 11 fingers were operated immediately after injury, one finger was repaired several days after injury. We transferred a total of 5 thenar perforator flaps, 1 groin flap, 5 great toe fibular flaps, and 1 medial plantar artery perforator flap to repair volar soft tissue defects with bony or tendon exposure of fingers. The artery of these flaps was connected to the proper digital artery. One or two veins of the flap were anastomosed to the volar digital veins in the recipient site. In searching for the volar veins of the finger, we first debrided the recipient site and explore the proper digital artery and volar veins at the proximal edge of wound. Then the flap can be designed with a short pedicle of 1-1.5 cm. The anastomosed volar veins were less than 0.5 mm in diameter. We used 12-0 sutures to vascular anastomosis.

Results and Conclusions: All the transferred flaps survived, no vessel crisis happened. The flap covered the defect site sufficiently and scar of operation is minimal and no circulation problems after surgery. Using volar digital veins as recipient veins is a novel attempt. The merits of this approach is that scar of operation is very limited. We transferred the flap based on a short pedicle, which decrease surgical time. The important findings from our series of 12 fingers indicate that volar vein can be used as recipient veins of the flap transfer in the finger, though traditionally dorsal veins are used because they are large and can be easily dissected. We suggest that volar veins can be considered as the recipient veins for free flap transfers in the fingers, provided that the surgeons are prepared to do finer vascular anastomosis of veins with diameter less than 0.5 mm.