gms | German Medical Science

Objectives/Interrogation: Soft tissue defects of the fingertip vary shapes and sizes, and in most cases, they can be covered with secondary delayed healing, skin grafting or local flap surgery. However, in the case of relatively large volar soft tissue defect extending to the distal interphalangeal joint or more proximal, it is difficult to recover. The donor site skin condition for volar skin loss on the digit should be glabrous, sensate and provide padding or cushion. We report a case of reconstruction for large volar soft tissue defect on a finger using radial artery superficial palmar (RASP) branch free flap and discuss related literature.

Methods: A 61-year-old female patient had no history of diabetes or peripheral vascular disease. Her left hand rolled into a meat grinder and her 2nd and 3rd digits were crushed accompanying with the fracture of the distal and proximal phalanx. Emergency surgery was performed on the day of the visit. The index was subjected to arterial anastomosis using a vein graft after reduction and internal fixation of the fracture site, and for the middle, reduction and internal fixation of the fracture site and end to end artery and vein anastomosis was performed. Skin necrosis of the second finger was observed at 2 weeks after surgery. After debridement of the necrotic tissue, soft tissue coverage was performed with a 3 x 1.5 cm sized RASP branch free flap. At 6 months follow-up, the flap was well-engrafted without loss and showed a 9-mm static two-point discrimination at 1-year follow-up.

Results and Conclusions: For relatively large volar soft tissue defect of the digit, Homo or Hetero-digit island flap can be applied. However, if the defect is too large, donor tissue may be insufficient or the pedicle may be short. Also, finger stiffness may be retained due to donor scar formation. Therefore, it is often necessary to reconstruct the defect with a sensate free flap which has similar skin texture with skin pulp. Typical flaps satisfying these conditions include free flap from the foot and toes or palm. The thenar free flap has some advantages of obtaining a wider flap, showing similar skin color and less donor morbidity compared with the flap of the toe. In addition, the donor and recipient are in the same surgical field.

The radial artery superficial palmar branch free flap is a good indication for the reconstruction of large volar soft tissue defects on the digit which is not covered by locoregional flap or island flap, and it has the advantage of less donor site morbidity.