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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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The Digital Artery Perforator Flaps and Dorsal Metacarpal Artery Perforator Flaps for Treatment of a Soft Tissue Defect of the Finger – Versatile Coverage Options to Avoid the Use of a Skin Graft

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  • presenting/speaker Kiyohito Takamatsu - Yodogawa Christian Hospital Dept. of Orthop. Surg., Osaka, Japan
  • Akira Kawabata - Yodogawa Christian Hospital, Osaka, Japan
  • Yuusuke Sogabe - Yodogawa Christian Hospital, Osaka, Japan
  • Yukiko Morimoto - Yodogawa Christian Hospital, Osaka, Japan
  • Ema Onode - Osaka City Univ Dept of Orthop. Surg., Osaka, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1215

doi: 10.3205/19ifssh1028, urn:nbn:de:0183-19ifssh10284

Published: February 6, 2020

© 2020 Takamatsu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: The digital artery perforator (DAP) flap, which was first reported by Koshima, is useful in the reconstruction of a soft tissue defect of the finger. Recently, many studies using the DAP flap have been published. However, to adequately close the donor site, Koshima recommended that the DAP flap should be no more than 10 mm wide. If the width of the flap exceeds 10 mm, full-thickness skin graft may be required at the donor site. This type of graft is associated with some complications, and the need of a second donor site to harvest a skin graft is inevitable. Therefore, to avoid the use of a skin graft, the dorsal metacarpal artery perforator (DMAP) flap is used in cases of large soft tissue defects.

Purpose: The aim of this study was to describe the therapeutic strategy for and clinical experience while treating soft tissue defects of fingers using the DAP and DMAP flaps to avoid the use of a skin graft for donor site closure.

Patients: The included patients (n = 14, all males; average age: 41.7 years, range: 24-84 years) were diagnosed with soft tissue defect of the fingers. The soft tissue defects of the patients included 10 cases of trauma and 4 of scar contracture. The follow-up period averaged 9.6 months.

Methods: The size of the actual skin defect was measured during surgery; the DAP flap was used for reconstruction of the defects with widths of 10 mm or less, and DMAP flap was used when the widths exceeded 10 mm. This study retrospectively investigated the type of perforator flap, size of the flap, and complications.

Results and Conclusions: All DAP and DMAP flaps survived completely. For the soft tissue defects due to trauma, there were seven cases of DAP flaps and three of DMAP flaps. For the four cases of scar contracture, the DAP flap was used for all. Notably, all donor sites could be closed. The average size of all flaps was 10.3 × 27.4 mm2. The average size of the DAP flap was 8.9 × 21.2 mm2 and of the DMAP flap was 15.7 × 50 mm2. The complication of delayed wound healing in the distal part of the flap occurred in one DMAP flap. Congestion was observed in another DMAP flap, and a leech was used. In all cases, there was no infection, hematoma, and additional surgery.

Use of skin graft to donor site was avoided in all cases, and all donor sites could be successfully closed. Following careful consideration, DAP and DMAP flaps were useful for reconstruction of soft tissue defects of the fingers.