J Korean Soc Surg Hand.  2015 Dec;20(4):153-160. 10.12790/jkssh.2015.20.4.153.

The Usability of Medial Sural Artery Perforator Flap for Reconstruction of the Finger Defects

• Hwang MK
• Chu SC
• Hwang SM
• Kim HD
• Kim MW
• Lee JS

• KMID: 2150396
• DOI: http://doi.org/10.12790/jkssh.2015.20.4.153

Abstract

PURPOSE
Groin or abdominal flap, anterolateral thigh free flap, and radial forearm flap can typically be performed in large defects, however satisfactory results in functional recovery and aesthetic aspect have not been achieved using these methods. Medial sural artery perforator free flap is recommended as a complement to these disadvantages, therefore we report the functional and aesthetic results of this flap for reconstruction of large finger defects.
METHODS
From January 2008 to December 2013, 10 patients with large soft tissue defect of the fingers were treated with medial sural artery perforator free flap. Six months after the final surgery, metacarpophalangeal joint and proximal interphalangeal joint range of motion was measured, and the circumference of the reconstructed finger was compared with that of the contralateral side. In addition, for assessment of the aesthetic satisfaction, the patients and three physicians compared the color of the reconstructed finger with that of adjacent skin on a five-point scale.
RESULTS
The flaps survived without complications in all ten cases. Average flexion was 77 degrees in the metacarpophalangeal joint and 84 degrees in the proximal interphalangeal joints. The average circumference of the reconstructed finger was measured as 12 percent larger than contralateral. The patien's subjective satisfaction (4.1) and physicians' objective satisfaction (4.2) regarding aesthetic aspect were very good.
CONCLUSION
Medial sural artery perforator free flap is a very thin, stable, fasciocutaneous flap which has a tendon gliding effect and produces aesthetically good results. Therefore we consider medial sural artery perforator free flap as the flap which can solve the drawbacks of other techniques associated with large finger defect reconstruction.

Keyword

Finger defect; Medial sural artery perforator flap

MeSH Terms

Arteries*
Complement System Proteins
Fingers*
Forearm
Free Tissue Flaps
Groin
Humans
Joints
Metacarpophalangeal Joint
Perforator Flap*
Range of Motion, Articular
Skin
Tendons
Thigh
Complement System Proteins

Figure

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  Fig. 1. (A) Preoperative view. (B) Circumferential coverage using medial sural artery perforator free flap. (C) Compare the circumference of reconstructed finger to contralateral normal ring finger on postoper-ative 6 months. (D) Compare the joint flexion of reconstructed ring finger to index finger of groin flap on postoperative 6 months.

• 

  Fig. 2. (A) Preoperative view. (B) Intraoperative finding of medial sural artery perforator free flap harvesting. (C) Circumferential coverage using medial sural artery perforator free flap. (D) Postoperative 12 months view.

Reference

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