Summary
Background
Reconstruction of severe hand injuries remains a challenge. We herein report the use
of dorsalis pedis composite free flaps (DPCFFs) for the reconstruction of penetrating
injuries of the hand.
Methods
From July 2001 to February 2009, 23 patients (15 males and 8 females), mean age of
26 years (range, 17–48 years), with penetrating wounds of the hand were treated with
DPCFFs. A second toe composite flap was used in cases of bone, joint, tendon and skin
defects, and combined flaps were used for patients with only soft-tissue defects.
Total joint transplantation using the proximal interphalangeal joint of the second
toe was used in 10 cases, compound flaps using the metatarsophalangeal joint of the
second toe were used in six, and combined dorsalis pedis flaps were used in seven
cases of soft-tissue loss.
Results
All flaps survived, no bone nonunion or malunion occurred, and primary healing was
achieved at all recipient and donor sites. Mean follow-up was 11 months (range, 6–27
months). In all cases, hand function was satisfactory and aesthetic outcome was good.
Sensory recovery ranged from S2 to S3. In six cases with transplanted metatarsophalangeal
joints, the mean range of flexion and extension was 45° (range, 30–70°). In 11 cases
with transplanted proximal interphalangeal joints, the mean range of flexion and extension
was 65° (range, 35–90°). No patient experienced difficulty walking.
Conclusion
DPCFFs are useful for the repair of composite tissue defects of the hand.
Levels of evidence
III.
Keywords
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Article info
Publication history
Published online: May 28, 2012
Accepted:
April 30,
2012
Received:
August 31,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
