Fascial Free Flap for Reconstruction of the Dorsolateral Hand and Digits: The Advantage of a Thin Contour

Abstract

Background: Fascial free flaps have been widely used for reconstruction of the hand because they are thin. However, studies reporting objective data regarding the advantages of this approach are lacking. Thus, we report our experience with such flaps.

Methods: Forty-five cases of fascial free flaps between November 2006 and March 2014 were reviewed. Nine cases involving reconstructed dorsal or lateral defects were included. Four anterolateral thigh fascial free flaps and 5 lateral arm fascial free flaps were examined. Maximal flap contour was assessed by measuring reconstructed tissue thickness at the central area from the surface of the skin to below the bone in a vertical manner using ultrasonography and X-ray data. Contralateral regions were examined in the same manner and a comparative analysis was performed. A questionnaire survey regarding aesthetic satisfaction was also administered.

Results: All reconstructed parts had a thicker contour than the contralateral side. The average relative percentage of reconstructed tissue thickness was found to be 152% using ultrasonography and 143% using X-ray imaging. According to the aesthetic satisfaction survey, the average rate of satisfaction for patients was 62%, and satisfaction with the flap contour was 72%.

Conclusions: Using a fascial free flap, the reconstructed tissue was approximately 1.5× as thick as the contour of the normal side, which led to positive responses regarding aesthetic satisfaction.

Keywords: Fascia; Free tissue flaps; Patient satisfaction; Thinness.

Fig. 1. Measurement of reconstructed tissue thickness

The thickest point in the central quarter of the flap was measured. The perpendicular distance from the skin surface to the bone below was measured and compared to the normal skin. (A) A yellow circle indicates fascial flap territory and a blue dotted circle indicates the central area measured by ultrasonography. (B, C) A red arrow indicates the perpendicular distance from the skin surface to the bone below. (D) The X-ray image was measured likewise.

Fig. 2. Relative percentage of reconstructed tissue thickness

The contour of all fascial flaps was thicker than that of the contralateral normal side. The average relative percentage of reconstructed tissue thickness assessed on ultrasonography was 152%, similar to 143% assessed using X-ray imaging.

Fig. 3. The patient in case 1

Case 1 was a patient whose middle and ring fingers were reconstructed using an anterolateral thigh fascial free flap. (A, B) Preoperative defects with tendon and bone exposure. (C, D) An anterolateral thigh fascial free flap covered the defects. (E, F) An acceptable thin contour is shown at an 8-year follow-up. (G, H) The overall range of motion was satisfactory.

Fig. 4. The patient in case 3

Case 3 was a patient whose hand was reconstructed using a lateral arm fascial free flap. (A) The initial mutilated state of the left hand after amputation. (B) A lateral arm fascial free flap covered the defects. (C, D) Follow-up at 3 years and 2 months.