Dorsal hand reconstruction with radial artery perforator-based adipofascial flap

Abstract

Reconstruction of dorsal hand soft tissue defects after severe injury is challenging for surgeons. Depending on the degree of defect, extensor tendon reconstruction may also be necessary. Various reconstruction methods are commonly performed to cover dorsal hand defects, such as skin grafting and distant, free, or local flaps. Among them, free vascularized flap transplantation is an ideal procedure because the major vessels that feed the local flap may have been damaged, and the affected limb can be reconstructed using a flow-through method. Although free flap surgery has advanced, few surgeons can choose this option due to its technical difficulty and uncertainty. On the other hand, distant flaps have been commonly used for the reconstruction of dorsal hand defects, and local flaps, such as reverse forearm flaps and retrograde posterior interosseous flaps, do not require microvascular anastomosis. However, they have some problems; distant flaps require at least two surgeries, reverse forearm flaps sacrifice major vessels and leave a scar at the donor site, and retrograde posterior interosseous flaps require meticulous dissection of the vascular pedicle. The radial artery perforator-based adipofascial flap is a versatile flap that is safe and easy to elevate without sacrificing the radial artery. In addition, elevating it as an adipofascial flap enables surgeons to avoid an unacceptable donor scar. We present two cases, demonstrating the usefulness of this pedicled perforator flap.

Keywords

Perforator / dorsal hand reconstruction / adipofascial flap / hand replantation / color Doppler ultrasonography

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