Free “Mini” Flaps for Reconstruction of the Digits

Purpose: Trauma to the fingers may leading to the soft tissue and bone loss. Reconstructions of the digits are usually achieved by homodigital flaps, heterodigital flaps or vascular island flaps from the hand or forearm. However, free tissue transfers are indicated when the defect is large, circumferential or involves several digits. In this study, we present our experience using free “mini flaps” for the reconstructions of the digits.

Materials and Methods:We retrospectively reviewed the case-notes of all patients who had a free “mini” flaps to digits following trauma. Sixteen patients with 19 digits were treated with  free flaps were identified. From May 2006 to April 2013, there were 19 digits treated with 16 free “mini” flaps in our hospital. Among them, there were 5 groin skin flaps, 3 groin chimeric skin flaps, 2 groin osteocutaneous flaps, 4 partial toe flaps and 2 dorsal metacarpal artery flaps.

Results: The average flap size was 5.0 x 2.1 (range 2x1.5-8x6) cm. The mean age of the patients was 38.2 years (range: 20–72 years) and there were 12 men and 4 women. The average operative time was 6.0 (range from (4-9) hours and all flaps survived without partial or total necrosis.

Conclusions: The free "mini" flap is a reliable and safe alternative for digital reconstruction. Using dorsal metacarpal artery flaps for dorsal finger coverage, partial toe flaps for pulp reconstruction and groin flap for multiple fingers coverage and bone lengthening is recommended.