Digital skin defect management: Hand and wrist volar flap solutions

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024-11, Vol.29 (6), p.1395-1400
• Main Authors: Tsumura, Takuya, Matsumoto, Taiichi, Imanaka, Toshihide, Ito, Hiromu
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Finger Injuries - surgery; Humans; Male; Middle Aged; Oblique triangular flap; Plastic Surgery Procedures - methods; Radial artery superficial palmar branch flap; Range of Motion, Articular; Retrospective Studies; Reverse homodigital island flap; Surgical Flaps; Unilateral pedicled volar VY advancement flap; Volar skin defects of the digits; Young Adult
• ISSN: 0949-2658; 1436-2023; 1436-2023
• DOI: 10.1016/j.jos.2023.11.009

Selecting the optimal flap for managing digit skin defects is challenging, particularly for inexperienced surgeons, given the numerous reconstructive options and insufficient evidence supporting one flap type's superiority over another. This retrospective study introduces four efficacious hand flaps to address volar skin defects and transverse and oblique cuts, examines the optimal flap advancement distance, and discusses effective management. Patients with digit skin defects who underwent flap surgery between 2009 and 2022 were included. Fifty-four patients treated with oblique triangular, volar VY advancement (unilateral and bilateral pedicled volar VY advancement flaps for fingers and thumbs, respectively), reverse homodigital island, and radial artery superficial palmar branch flaps were included. We evaluated the flap advancement distance, flap length, range of motion, complications, and Semmes–Weinstein monofilament test and Disabilities of the Arm, Shoulder, and Hand questionnaire results. The median flap advancement distances for triangular oblique (19 patients), unilateral (11 patients), and bilateral pedicled (5 patients) volar VY advancement flaps were 1.3, 1.8, and 2.0 cm, respectively. The flap lengths for the reverse digital island (8 patients) and radial artery superficial palmar branch (11 patients) flaps were 2.4 and 5.0 cm, respectively. Five, three, and one cases of proximal interphalangeal flexion contractures of ≥ -20° were observed in the VY advancement, reverse digital island, and radial artery superficial palmar branch flaps, respectively. One unilateral VY advancement flap case caused severe numbness and neuroma. All complication cases featured >15 and > 20 mm defect lengths on the fingers and thumb, respectively. To minimize sensory disruption and contractures, we recommend oblique triangular and unilateral pedicle volar VY advancement flaps for finger skin defects up to 12 mm and defects sized 12–15 mm, respectively. Advancement flaps are unsuitable for >15 and > 20–25 mm defects on the fingers and thumb, respectively.