Fingertip Reconstruction with Adipofascial Island Flap

Purpose

The fingertip reconstruction requires durable coverage, with good color and contour, so that, adequate coverage of fingertip wounds is often a demanding problem for hand surgeons.¹ Fingertip defect with bone exposure should be covered as promptly because of its chance of infection and bone desiccation. Adipofascial flap is one of the methods covering soft tissue defect at fingertip. This study is designed to show the new method of fingertip reconstruction using a pedicled adipofascial island flap.

 

Methods

From August 2014 and June 2015, 8 patients with fingertip soft tissue defect were treated. After dissecting subdermal layer of undamaged area to expose subcutaneous tissue, we elevated adipofascial flap based on branches from terminal arch of digital arteries. And we sacrificed one side of terminal arch of digital artery, which become adipofascial island flap pattern with comparatively longer pedicle. After that, we transposed the flap onto the bone exposure area. Only the remaining skin layer of the donor site was sutured primarily. 3 weeks after the surgery, split thickness skin graft was performed on the adiopofascial flap as the second stage of the procedure.

Results

The 8 patients ranged in age from 30 to 62 years old; seven males and one female presented with acute injuries to the fingertip. Mean follow-up period was about 8 months. All the adipofascial island flaps survived completely and provided excellent soft tissue coverage, and all the skin grafts were taken well. There were no complications, such as infection, re-exposure of bone. And the donor site showed no significant morbidities, such as hematoma and dehiscence. During the follow-up period, there was no atrophy and the appropriate soft tissue padding was provided. All patients were satisfied with round fingertip contour.

Conclusion

Adipofascial island flaps constitute an excellent option because of their thinness, good pliability, and minimal donor site deformity and the simplicity and rapidity of the procedure.² Other advantages were constant anatomic pedicle of the flap, primary closure of donor site and one operative field. This flap can be performed within one digit, which benefits covering the defect with bone exposure immediately without any preparation of other donor site. We consider the adipofascial island flap is another reliable and useful method for the fingertip reconstruction.