Syndactylization-Desyndactylization Method in the Hand in Addition to Medial Sural Artery Perforator Flap Applications

Introduction: The posterior leg area provides an excellent flap option for specific injuries such as the hands and feet in patients with respectively thinner skin. The medial sural artery perforator Flap (MSAPF) was first performed in 2001 as a modification of classic gastrocnemius myocutaneous flap by Cavadas et al. (1). Later, many studies were published in the literature about flap vascularization and its clinical use (2-4). It became a very useful flap in repairing small and moderate sized defects, including the head and neck region. The length of vascular pedicle ranges from 9 to 16 cm. The flap size varies from 4x8x12x13 cm3. The aim of the current study was to reveal a new area of use for the medial sural artery perforator flap in addition to its use in the foot area, and the repair of volar defects in the hand, including more than one finger.

Methodology and Material: Between August 2011 and August 2013, five MSAPFs were used in the repair of hand and foot defects. All patients were males, aged between 22-25 years. The patients’ clinical data are given in Table 1. One patient was operated on for a non-healing wound after a chemical burn on the dorsum of the foot; two patients were operated on for previous volar burn contractures of the finger; one patient was operated on for a heel defect after a previous burn; and one patient was operated on for an open wound after a traffic accident on the dorsum of the first toe. The dorsal branch of radial artery at the snuff box and cephalic radial veins were used as recipient vessels.

Results: Among the five patients there were two post-burn contracture at the volar region, two chemical burns on the dorsum of the foot, and one post-burn defect. The size of the flaps ranged from 6x to × 17.5 cm. The length of the vascular pedicle was 8 to 12 cm. Mean follow-up period was 10 months. The donor areas larger than 5 cm width were closed with skin flaps. All flaps survived. There were no complications of the recipient size.

Conclusions: In conclusion, using free medial sural artery perforator flap is ideal for repairing the small- to medium sized defects in the hand and on the foot. The medial artery sural perforator flap is a useful flap in areas such as the hands and feet where thin skin is required. In conditions where more than one finger should be repaired, flaps can become more useful by syndactylization, and desyndactylization three months later. According to the appropriate defects of recipient anatomic regions the MSAP flap is able to offer a proper alternative in reconstruction of hand and foot.