2012 Volume 25 Issue 4 Pages 188-195
We report reconstruction for severe finger injuries using wrap-around flaps (WAFs) that include the second toes, distal second toe transfer, hemipulp flaps, arterialized venous flaps (aVF), free dorso-ulnar perforator flap (FDUPF), and free first dorsal metacarpal artery flap. We report the clinical outcomes and provide a discussion. This series included 37 fingers, from 32 men and 5 women ranging in age from 19-62 years, that sustained complete or incomplete amputations and crush injuries. WAFs were used for 16 fingers, distal second toe transfer for 3 cases, and hemipulp flaps for 7 fingers.FDUPFs were used for 5 fingertips, aVFs for 5 fingertips, and free dorsal metacarpal artery flap for 1 case, especially targeting reconstruction of the palmar soft tissues at the distal parts of the fingers, paying attention to both the esthetic appearance and function. All of the WAFs, the distal second toe transfers, hemipulp flaps, FDUPFs, and free dorsal metacarpal artery flaps survived. Superficial layer necrosis was observed in 1 case in which aVF was used. Our results suggested that WAFs were superior for the reconstruction of fingertips including nail reconstruction, from the points of view of both cosmetic appearance and functionality. For patients who do not want to undergo tissue transplantation from the foot, reconstruction using aVFs, which can be performed under conduction anesthesia, free first dorsal metacarpal artery flap, or using FDUPF, which have a small harvesting area, are also useful.
