Semin Plast Surg 2020; 34(03): 192-199
DOI: 10.1055/s-0040-1715155
Review Article

Propeller Flaps for Hand and Digit Reconstruction

Pierluigi Tos
1   Hand Surgery and Reconstructive Microsurgery Department, ASST Gaetano Pini-CTO, Milan, Italy
,
Alessandro Crosio
1   Hand Surgery and Reconstructive Microsurgery Department, ASST Gaetano Pini-CTO, Milan, Italy
,
Pierfrancesco Pugliese
2   Plastic and Reconstructive Surgery Department, AOU Policlinico Paolo Giaccone, Palermo, Italy
,
Alexandru Valentin Georgescu
3   Plastic Surgery and Reconstructive Microsurgery Department, Clinical Hospital of Rehabilitation, University of Medicine Iuliu Hatieganu, Cluj-Napoca, Romania
› Institutsangaben

Abstract

The reconstruction of soft tissue defects of the hand, as seen often after trauma or tumor excision, is a challenge due to the great differentiation of tissues depending on the hand area involved. The classical intrinsic “workhorse flaps” of the hand are associated with a significant donor-site morbidity. Capturing perforator vessels in discrete donor areas can reduce the amount of soft tissue that has to be dissected and included in what now would be a perforator flap, while also insuring robust vascularization of those transferred tissues. Moreover, the presence of perforator vessels both on the dorsal and volar sides of the hand allows harvest of perforator flaps that will respect the like-with-like principle by maintaining the main characteristics of volar and dorsal skin as desired. However, the dissection of these flaps, especially those based on volar palmar and digital perforators, still requires microsurgical skills to preserve the fine vascularization of these flaps. These small flaps are also amenable for application of the propeller flap concept. This is an especially valuable means for preserving the length of an amputated finger where bone is exposed by using more proximal uninjured tissues. Although in general only a short dissection is required to raise a propeller flap in this region, most often the donor site will have to be closed by a skin graft.



Publikationsverlauf

Artikel online veröffentlicht:
22. September 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 
  • Reference

  • 1 Lai-jin L, Xu G. The reverse dorsal metacarpal flap: experience with 153 cases. Ann Plast Surg 2006; 56 (06) 614-617
  • 2 Maruyama Y. The reverse dorsal metacarpal flap. Br J Plast Surg 1990; 43 (01) 24-27
  • 3 Quaba AA, Davison PM. The distally-based dorsal hand flap. Br J Plast Surg 1990; 43 (01) 28-39
  • 4 Bakhach J, Sentucq-Rigal J, Mouton P, Boileau R, Panconi B, Guimberteau J-C. The dorsoradial flap: a new flap for hand reconstruction. Anatomical study and clinical applications [in French]. Ann Chir Plast Esthet 2006; 51 (01) 53-60
  • 5 Dautel G, Merle M. Direct and reverse dorsal metacarpal flaps. Br J Plast Surg 1992; 45 (02) 123-130
  • 6 Toia F, Marchese M, Boniforti B, Tos P, Delcroix L. The little finger ulnar palmar digital artery perforator flap: anatomical basis. Surg Radiol Anat 2013; 35 (08) 737-740
  • 7 Omokawa S, Yajima H, Inada Y, Fukui A, Tamai S. A reverse ulnar hypothenar flap for finger reconstruction. Plast Reconstr Surg 2000; 106 (04) 828-833
  • 8 Kojima T, Endo T, Fukumoto K. Reverse vascular pedicle hypothenar island flap. Handchir Mikrochir Plast Chir 1990; 22 (03) 137-144
  • 9 Kinoshita Y, Kojima T, Hirase Y, Kim H, Endo T. Subcutaneous pedicle hypothenar island flap. Ann Plast Surg 1991; 27 (06) 519-526
  • 10 Vasconez LO, Velasquez CA, Rumley T. Correction of a first web space contracture with and arterialized palmar flap. In: Gilbert A, Masquelet AC, Hentz RV. , eds. Pedicle Flaps of the Upper Limb. Boston, MA: Little Brown; 1992: 135-138
  • 11 Kim KS, Hwang JH. Radial midpalmar island flap. Plast Reconstr Surg 2005; 116 (05) 1332-1339
  • 12 Omokawa S, Tanaka Y, Ryu J, Clovis N. Anatomical consideration of reverse-flow island flap transfers from the midpalm for finger reconstruction. Plast Reconstr Surg 2001; 108 (07) 2020-2025
  • 13 Orbay JL, Rosen JG, Khouri RK, Indriago I. The glabrous palmar flap: the new free or reversed pedicled palmar fasciocutaneous flap for volar hand reconstruction. Tech Hand Up Extrem Surg 2009; 13 (03) 145-150
  • 14 Tapan M, İğde M, Yıldırım AR, Yaşar B, Ergani HM, Duru Ç. Reverse thenar perforator flap for large palmar and digital defects. J Hand Surg Am 2018; 43 (10) 956.e1-956.e6
  • 15 Kawakatsu M, Ishikawa K. Dorsal digital perforator flap for reconstruction of distal dorsal finger defects. J Plast Reconstr Aesthet Surg 2010; 63 (01) e46-e50
  • 16 Hu H, Chen H, Hong J. , et al. Propeller perforator flaps from the dorsal digital artery perforator chain for repairing soft tissue defects of the finger. BMC Surg 2019; 19 (01) 188
  • 17 Koshima I, Urushibara K, Fukuda N. , et al. Digital artery perforator flaps for fingertip reconstructions. Plast Reconstr Surg 2006; 118 (07) 1579-1584
  • 18 Matei IR, Bumbasirevic M, Georgescu AV. Finger defect coverage with digital artery perforator flaps. Injury 2019; 50 (Suppl. 05) S95-S98
  • 19 Mitsunaga N, Mihara M, Koshima I. , et al. Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction. J Plast Reconstr Aesthet Surg 2010; 63 (08) 1312-1317
  • 20 Delia G, Battaglia F, Colonna MR, Barresi V, d'Alcontres FS. Is the adipofascial flap the key to regenerative surgery?. JPRAS Open 2018; 18: 49-58
  • 21 Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F. Repair and reconstruction of thumb and finger tip injuries: a global view. Clin Plast Surg 2014; 41 (03) 325-359
  • 22 Tos P, Adani R. Finger amputations and pulp defects distal to the distal interphalangeal joint. J Hand Surg Eur Vol 2019; 44 (10) 1105-1106