Dividing the flap: 3-week temporary syndactyly to reconstruct multidigital soft tissue injuries with single free flaps. A proof of principle

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2022-12, Vol.75 (12), p.4496-4512
• Main Authors: Alsina-Rius, Gloria, Nunez-Villaveirán, Teresa, Davila, Armando, Ferreira-Montenegro, Bartolome
• Format: Article
• Language: English
• Subjects: Free flap; IV. Therapeutic; Multidigital injury; Revascularization; Soft-tissue reconstruction; Syndactyly
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2022.10.030

Traumatic injuries of the hand and fingers that involve more than one digit can be treated with a single flap in syndactyly.  We demonstrate that syndactyly release can be performed safely using serial clamping/epinephrine injections between POD 19 and 21. We performed reconstruction of multiple finger injuries with single free flaps and temporary syndactylies in 22 patients. The size of the flaps ranged from 2.5 x 4.5 cm to 7 x 21 cm. At postoperative day (POD) 7, interdigital flap compression was started using vascular clamps, or at POD 10 using 1:200,000 epinephrine injections. The compression was initially held for 10 min and gradually increased to 2 h by the end of POD 20. Syndactyly release was performed between POD 19–22. Complications were seen in 3 patients and included two partial flap loses and a venous thrombosis that was salvaged by using an antebrachial vein bypass. There were no complete flap loses. Flap debulking was needed in 14 cases. Our flap of choice for multi-digital reconstruction is currently the SCIP flap.